Journal of Vascular Diseases doi: 10.3390/jvd5030027

Authors: Yuji Shimizu Asuka Oyama Yuko Noguchi Mutsumi Matsuu-Matsuyama Koichiro Hamada Shin-Ya Kawashiri Hirotomo Yamanashi Seiko Nakamichi Yasuhiro Nagata Takahiro Maeda Naomi Hayashida

Background/Objectives: This study examined the association between self-reported walking pace and subclinical hypothyroidism (SCH) in relation to atherosclerotic status, as both walking pace and SCH have been linked to an increased risk of all-cause mortality and cardiovascular disease. The vascular network underlying atherosclerotic processes may help explain this relationship. Methods: This was a cross-sectional study involving 1719 Japanese with normal thyroid function (free triiodothyronine [T3] and free thyroxine [T4] levels within the normal range). Since all individuals who participated in this study had free T3 and free T4 levels within the normal range, those with elevated TSH levels (>4.01 μIU/mL) were classified as having SCH. Self-reported faster walking pace was identified based on the participants’ responses to whether they perceived themselves as walking faster than their peers of the same age and sex. Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for SCH. Results: Of the study participants, 166 had atherosclerosis and 98 had SCH. Among individuals without atherosclerosis, a self-reported faster walking pace was significantly inversely associated with SCH but not among those with atherosclerosis. The sex and age-adjusted ORs (95% CIs) of SCH for self-reported faster walking pace were 0.58 (0.37, 0.91) for those without atherosclerosis and 2.35 (0.75, 7.36) for those with atherosclerosis. Atherosclerosis showed a significant interaction with the association between SCH and self-reported faster walking pace, with sex- and age-adjusted p-values of 0.027. These associations persisted, even after adjusting for potential confounding factors. Conclusions: Self-reported faster walking pace is inversely associated with SCH in individuals without atherosclerosis but not in those with atherosclerosis. Atherosclerosis status may influence the association between SCH and self-reported faster walking pace.

Journal of Vascular Diseases doi: 10.3390/jvd5030026

Authors: Ryan Cysne Mire Corrêa Jhonatan Martins de Souza Giovane Coimbra Nascimento Pedro Tuma Leonardo Gustavo Vieira de Oliveira

Objectives: This study investigated the effects of exercise selection and rest interval duration on post-exercise cardiac autonomic modulation following resistance exercise (RE). Methods: Eleven (4 females) resistance-trained individuals performed a single RE session consisting of either a multi-joint exercise (back squat) or a single-joint exercise (leg extension), using rest intervals of 1 or 2 min between sets. Heart rate variability (HRV) was assessed at baseline (pre-exercise) and 30 min following the RE session. RR intervals were recorded for 15 min with participants resting in the supine position on an examination bed in a quiet environment. For HRV analysis, a 5-min artifact-free segment of RR intervals was selected and processed using Kubios HRV software, version 4.3.0 (Kubios Oy, Kuopio, Finland). The HRV metrics analyzed included the root mean square of successive differences (RMSSD), low-frequency normalized (LF), the low-frequency/high-frequency (LF/HF) ratio, and the standard deviation of transverse dispersion (SD1). Results: A significant main effect of time was observed for RMSSD, LF, and the LF/HF ratio. The back squat exercise elicited a significant reduction (p < 0.05) in vagal-related indices (RMSSD and SD1) regardless of interval duration. Longer rest intervals were associated with increased (p < 0.05) sympathetic modulation, as reflected by higher LF and LF/HF values 30 min post-exercise. No significant time × group interactions were observed for most HRV variables. Conclusions: Exercise selection and rest interval duration differentially influence post-exercise cardiac autonomic responses following RE. Multi-joint exercises induce greater vagal withdrawal, whereas longer rest intervals favor sympathetic predominance during recovery. These findings highlight the importance of manipulating RE variables to manage autonomic stress and recovery.

Journal of Vascular Diseases doi: 10.3390/jvd5030025

Authors: Jovita I. Mbah Phillip T. Bwititi Prajwal Gyawali Lin Kooi Ong Ezekiel U. Nwose

Introduction: Blood viscosity is elevated in diabetes and is inversely related to blood flow. The pathology evidence base associated with blood stasis, namely hematocrit and serum total protein levels, is negatively correlated with age, but affordable pathology tests for blood stasis remain underutilized in clinical medicine practice. This study is intended to evaluate changes in estimated whole blood viscosity (eWBV) with age and gender, as an index of blood stasis and its associated indices of hematocrit and serum total protein levels. Method: This was a clinical laboratory observational retrospective study involving 10 years of pathology data. Three clinical medicine parameters, including eWBV, hematocrit and proteinemia, were compared in stratified age groups. Data were those monitored for HbA1c (N = 21,021). Statistical analysis included univariate (ANOVA) and multivariate (MANOVA) as well as correlation. Results: Average levels of proteinemia, hematocrit and eWBV were different in stratified age groups, and lower in females compared to males. MANOVA analysis shows a significant difference in the three clinical medicine parameters between the younger adults and the elderly (p < 0.001). Age and eWBV are inversely correlated, but this may be negligible with diabetes (r = −0.17). Discussion: There are age-related and gender differences in the pathology evidence base that underpins blood viscosity. The implication of lower blood viscosity in women and the elderly is a higher risk of bleeding. The potentially higher risk of bleeding with increasing age is contrary to the concern for thrombosis, which means that antiplatelet prophylaxis among the elderly may be confounded.

Journal of Vascular Diseases doi: 10.3390/jvd5030024

Authors: Benedict Apaw Agyei Ijeoma Chinedum Anyitey-Kokor Andrew Donkor Fred Stephen Sarfo Yaw Amo Wiafe

Background: While cardiovascular diseases (CVD) manifest in adulthood, vascular changes may begin in childhood. Early markers of CVD, such as carotid intima-media thickness (CIMT), have not been well studied in children in the African setting. The potential influence of environmental and genetic factors on the CIMT of African children is not well understood. Objective: This study assessed the cardiovascular risk profiles of Ghanaian children and adolescents in rural and urban settings using carotid intima-media thickness (CIMT) and ultrasound-measured adiposity. Methods: A cross-sectional study was conducted involving 343 asymptomatic, healthy school children (10–16 years) from the Ashanti region of Ghana. Participants were recruited from one urban and one rural school. Data collected included height, weight, blood pressure, and ultrasound measurements of CIMT, subcutaneous, preperitoneal, and Visceral fat. Results: The mean CIMT for the cohort was 0.60 ± 0.07 mm. Urban children had significantly higher BMI (p < 0.001), subcutaneous fat (p = 0.005), and preperitoneal fat (p < 0.001) compared to rural children, yet there was no significant difference in CIMT between the two sites (p = 0.497). Multiple linear regression revealed that peritoneal fat thickness (p = 0.029) and male gender (p < 0.001) were significant predictors of CIMT, whereas BMI and blood pressure were not. Conclusions: Ghanaian children exhibit elevated CIMT values compared to Western pediatric cohorts despite having lower BMI and normal blood pressure. The significant correlation between peritoneal (visceral) adiposity and CIMT suggests that fat distribution is a more sensitive indicator of early vascular remodeling than BMI in this population. This highlights the need for population-specific screening strategies that move beyond BMI.

Journal of Vascular Diseases doi: 10.3390/jvd5030023

Authors: Davide Costa Nicola Ielapi Alessia Talarico Antonio Mazza Raffaele Serra

Transgender individuals face unique challenges in vascular health due to the complex interactions between gender identity, psychosocial determinants of health, and medical interventions such as gender-affirming hormone therapy (GAHT). Growing evidence indicates that transgender populations may exhibit distinct patterns of vascular disease risk compared with cisgender individuals; however, available data remain limited and heterogeneous. A narrative review of the literature was conducted using major biomedical databases to identify studies examining the vascular and cardiovascular effects of gender-affirming hormone therapy in transgender individuals. This review provides a comprehensive overview of vascular health in transgender people, with particular attention to both venous and arterial disease. We summarize current epidemiological evidence on vascular outcomes and explore biological mechanisms through which exogenous sex hormones, including estrogens, anti-androgens, and testosterone, may influence endothelial function, vascular remodeling, inflammation, and coagulation pathways. Specific emphasis is placed on venous disorders, such as thromboembolic disease and chronic venous disease (CVD), as well as arterial conditions, including chronic peripheral arterial disease (PAD). In addition, we discuss the contribution of traditional vascular risk factors, minority stress, disparities in healthcare access, and social determinants of health in shaping vascular risk profiles. Clinical implications for vascular risk assessment, prevention strategies, and long-term monitoring in transgender individuals receiving GAHT are addressed. Finally, key knowledge gaps and priorities for future research are identified, underscoring the need for robust, longitudinal studies to support personalized and evidence-based vascular care in transgender populations.

Journal of Vascular Diseases doi: 10.3390/jvd5030022

Authors: Nana Kwadwo Okraku-Yirenkyi Jeanine Williams Aimee Sun Ramya Natarajan John Crawford Charles West

Background: Acute aortic dissection compresses diagnosis, transfer, and operative readiness into a narrow time window in which hospital capability may influence survival. Yet U.S. studies define specialized or high-volume care inconsistently, limiting translation of the literature into actionable regionalization criteria. We reviewed U.S. evidence comparing outcomes for acute aortic dissection across hospitals categorized by procedural volume or center specialization. Methods: We performed a PRISMA-aligned systematic review with narrative synthesis. We searched PubMed, Embase, Scopus, Web of Science, and CINAHL for English-language, peer-reviewed studies published from January 2000 through July 2025. Eligible studies included adult U.S. cohorts with acute aortic dissection and reported outcomes stratified by hospital volume tier or center designation. Two reviewers independently screened studies and extracted study characteristics, exposure definitions, analytic approach, and outcomes. We assessed quality to inform interpretation. Results: Searches identified 457 records, and 7 observational U.S. studies met eligibility criteria. Across most studies, higher-volume or specialized-center care was associated with lower in-hospital or 30-day mortality. Two studies showed no meaningful difference. Hospital length of stay was often longer in higher-volume strata. Neurologic complications were inconsistently associated with the center category. Definitions and thresholds used to denote “high volume” or “aortic center” varied substantially across studies. Conclusions: In U.S. observational data, higher-volume or specialized-center care for acute aortic dissection is most consistently associated with improved short-term survival, whereas secondary outcomes are heterogeneous. A major barrier to implementation is definitional inconsistency. Future work should pair transparent volume thresholds with explicit, measurable system capabilities.

Journal of Vascular Diseases doi: 10.3390/jvd5030021

Authors: Gustavo Paludetto Natália de Carvalho Trevizoli Alexandre Augusto Giovanini Lethícia Mesquita Valadão Hícaro do Carmo Moreira Matheus Santos Cordón Gustavo Testoni Paludetto

Background: Acute portal vein thrombosis (aPVT) is a severe complication of the splanchnic venous system, often associated with portal hypertension, intestinal ischemia, and hepatic dysfunction. Anticoagulation is the first-line therapy but is frequently insufficient in advanced Yerdel grade III–IV cases, where recanalization rates remain low. Endovascular interventions have emerged as alternative therapeutic strategies in selected patients. Methods: We present three cases of patients with Yerdel grade III–IV aPVT who underwent endovascular management. The techniques included: (1) transhepatic aspiration thrombectomy combined with intra-thrombus thrombolysis using alteplase (Actilyse); (2) combined aspiration thrombectomy, intra-thrombus thrombolysis with alteplase, portal vein stenting, and transjugular intrahepatic portosystemic shunt (TIPS) creation; and (3) transsplenic aspiration thrombectomy followed by angioplasty, stent placement, and TIPS creation in a post-liver transplant patient. Results: All procedures were technically successful, achieving complete or near-complete recanalization of the portal venous system. Restoration of patency in the extrahepatic portal circulation was confirmed, and portal pressures were reduced in the TIPS-assisted case. No major periprocedural complications occurred. Clinical outcomes included preservation of transplant candidacy and graft salvage. Conclusions: Endovascular therapy may be an option in selected patients with acute portal vein thrombosis. Careful patient selection and an individualized technical approach are essential.

Journal of Vascular Diseases doi: 10.3390/jvd5030020

Authors: Hunter Hutchinson Chloe DeYoung Danyas Sarathy Grace Hey Wiley Gillam Shawna Amini Muhammad Abdul Baker Chowdhury Brandon Lucke-Wold Zachary Sorrentino Matthew Koch

Objective: The AXS Vecta 46 intermediate catheter (Stryker) features a large inner diameter, enabling effective aspiration, combined with a small outer diameter and soft distal-tip flexibility, which allows for safe tracking through more tortuous and smaller arterial segments to target medium vessel occlusions non-traumatically. The efficacy of the Vecta 46 in the spectrum of large and medium vessel occlusions has not been well elucidated in the literature. Methods: This retrospective cohort study included patients who underwent MT for acute ischemic stroke at our institution between July 2022 and June 2024. The outcomes of patients treated with Vecta 46 were compared to those of all other catheters used at the institution. Results: The distribution of aspiration and stent retriever attempts in Vecta 46 procedures versus non-Vecta 46 procedures was significantly different (p = 0.00325). Aspiration was attempted 1.66 ± 0.936 times in the Vecta 46 group and 1.12 ± 0.650 times in the non-Vecta 46 group (p = 0.00135). More mechanical thrombectomies with the Vecta 46 included aspiration of a secondary thrombus (p = 0.0314), despite no difference in the distribution of the primary or secondary occlusion location. There were no statistically significant differences in recanalization success (p = 0.800), recanalization time (p = 0.245), procedure duration (p = 0.580), discharge modified Rankin Score (p = 0.875), or intracranial hemorrhage rate (p = 0.720) between non-Vecta 46 and Vecta 46 procedures. Conclusions: Vecta 46 has similar safety and functional outcomes compared to other endovascular treatment options despite procedural differences.

Journal of Vascular Diseases doi: 10.3390/jvd5020019

Authors: Dimitrios Nikas Antonios Halapas Lampros Lakkas George Karaolanis Vaggelis Alexiou Dimitrios Chatzis Petros Kalogeras Christos Floros Xenofon Sakellariou Vasileios Bouratzis Michail Peroulis Katerina K. Naka Lampros Michalis

Transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with severe aortic stenosis. Despite significant procedural refinement, vascular complications (VCs) remain among the most frequent and clinically relevant adverse events associated with TAVI. These complications are closely associated with adverse clinical outcomes and continue to represent one of the most significant limiting factors for the broader expansion of TAVI indications to larger patient populations. Over the past decade, their incidence has declined substantially, largely due to device evolution, improved closure techniques, and the widespread adoption of meticulous pre-procedural imaging and planning. This narrative review provides a comprehensive overview of VCs in TAVI, focusing on contemporary incidence rates, underlying mechanisms, and patient as well as procedural-related risk factors. Additionally, the role of alternative access routes is discussed, alongside emerging technologies and future perspectives aimed at further reducing complication rates.

Journal of Vascular Diseases doi: 10.3390/jvd5020018

Authors: Pablo Albiña-Palmarola Ali Khanafer Hans Henkes

Vascular intervention has advanced technically faster than it has matured methodologically. Across neurovascular, carotid, peripheral, and aortic practice, complications and outcomes are often reported using different definitions, thresholds, surveillance strategies, adjudication methods, follow-up schedules, and units of analysis. As a result, studies that appear to assess the same treatment may in fact be measuring different outcome constructs. This problem is particularly visible in neurovascular intervention, where technical, radiographic, and clinical outcomes are often combined within the same evaluative framework. In acute ischemic stroke thrombectomy, changes in reperfusion thresholds can alter the meaning of procedural success. In intracranial aneurysm treatment, angiographic occlusion, retreatment, delayed stenosis, and neurological morbidity are often reported together despite representing different dimensions of efficacy and safety, while the interpretation of surrogate angiographic outcomes may vary across device classes. Similar issues arise in carotid intervention, peripheral endovascular therapy, and endovascular aneurysm repair, where composite outcomes, imaging-detected complications, and inconsistent surveillance protocols further complicate interpretation. These variations limit cross-study comparability, weaken meta-analytic synthesis, and may distort judgments about treatment effectiveness and safety. Endpoint heterogeneity persists partly through disciplinary silos, device-driven evaluation frameworks, and regulatory pathways that favor surrogate over clinical endpoints; addressing it will require not only better reporting but standardized outcome constructs, coordinated international registries, and broader adoption of core outcome set methodology. Greater discipline in endpoint definition and reporting, together with broader adoption of standardized outcome frameworks and core outcome set methodology, is needed if evidence in vascular intervention is to accumulate coherently.

Journal of Vascular Diseases doi: 10.3390/jvd5020017

Authors: Jacob Alejandro Strouse Sebastian Verrier Paz Alexander Gonzalez Brandon Lucke-Wold

Background: Intracranial fusiform aneurysms represent a rare but clinically aggressive subtype of cerebrovascular disease, characterized by circumferential arterial dilation and a high risk of growth, ischemic complications, and rupture. Unlike saccular aneurysms, fusiform lesions lack well-established medical therapies to prevent progression or stabilize the aneurysm wall. Tumor necrosis factor-alpha (TNF-α) has emerged as a central mediator of aneurysm-associated inflammation and vascular remodeling, raising interest in TNF-α modulation as a potential therapeutic strategy. This study aimed to systematically review and synthesize the available clinical and translational evidence evaluating TNF-α signaling and anti-TNF-α therapies in the context of intracranial fusiform aneurysms. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, and Google Scholar from database inception through February 2026 in accordance with PRISMA guidelines. Eligible studies included human, animal, and translational investigations examining TNF-α biology or anti-TNF-α interventions in relation to intracranial fusiform aneurysms, intracranial dolichoectasia, or vertebrobasilar dolichoectatic aneurysms. Study selection, deduplication, and screening were performed using Covidence systematic review software. Extracted outcomes included aneurysm growth, rupture, ischemic events, imaging characteristics, inflammatory signaling, and vascular remodeling. Given substantial heterogeneity in study design and outcome reporting, findings were synthesized narratively using structured evidence mapping. Results: From the 368 records identified, 14 studies met inclusion criteria following full-text review. Included studies encompassed preclinical models, translational mechanistic investigations, and limited clinical observational data. Across experimental models, TNF-α signaling was consistently associated with macrophage infiltration, matrix metalloproteinase activation, vascular smooth muscle cell phenotypic modulation, and aneurysm wall degeneration. TNF-α inhibition was associated with reduced aneurysm progression and rupture in preclinical settings, including when initiated after aneurysm formation. Clinical evidence remains limited but suggests a potential association between TNF-α modulation and aneurysm stability, although direct therapeutic data in intracranial fusiform aneurysm populations are sparse. Conclusions: The existing translational and preclinical evidence supports a contributory role for TNF-α-mediated inflammation in the progression of intracranial fusiform aneurysms and suggests that TNF-α inhibition may represent a promising disease-modifying strategy. However, clinical data remain insufficient to support routine therapeutic use. Prospective observational studies and early-phase clinical trials are needed to define the safety, timing, and efficacy of anti-TNF-α therapies in patients with intracranial fusiform aneurysms.

Journal of Vascular Diseases doi: 10.3390/jvd5020016

Authors: Marija Batkoska Kristina Drusany Starič Jernej Mlakar Marina Jakimovska

Background: Vascular malformations are congenital structural abnormalities of the blood vessels that may present at any age. In the vulvovaginal region, these lesions are uncommon and frequently misdiagnosed because their clinical appearance overlaps with common gynecologic conditions, particularly Bartholin’s gland cyst or abscess. Inappropriate surgical intervention without prior vascular evaluation may result in hemorrhage, incomplete treatment, and recurrence. Methods: A structured narrative review of the literature was performed using PubMed/MEDLINE and EMBASE databases (January 2000–April 2024) to summarize the classification, pathophysiology, clinical presentation, imaging characteristics, differential diagnosis, and management of vulvovaginal vascular malformations. Publications addressing vascular anomalies in other anatomical locations were also included when clinically relevant. A representative clinical case confirmed by histopathologic and molecular analysis is presented to illustrate the diagnostic pitfalls. Results: Vulvovaginal vascular malformations are predominantly low-flow venous lesions but may include high-flow arteriovenous malformations. A clinical examination alone is insufficient for diagnosis. Doppler ultrasonography is the recommended initial imaging modality, followed by magnetic resonance imaging to define the lesion extent and flow characteristics. Misdiagnosis most commonly occurs when lesions are treated as Bartholin’s gland pathology without prior imaging. Low-flow lesions are generally managed with sclerotherapy or planned surgical excision, whereas high-flow lesions require embolization and multidisciplinary care. Hormonal and hemodynamic changes, including pregnancy, may precipitate enlargement or thrombosis. Conclusions: Vascular malformations should be considered in the differential diagnosis of atypical vulvar masses. Preoperative imaging is essential in order to avoid inappropriate surgical procedures. A structured diagnostic approach combining clinical assessment and imaging enables correct classification and guides treatment. The presented case demonstrates a typical diagnostic pitfall and emphasizes the importance of recognizing vascular lesions in gynecologic practice.

Journal of Vascular Diseases doi: 10.3390/jvd5020015

Authors: Denise Baloi Henry Freeman Moneebah Ashraf Michael Karsy Brandon Lucke-Wold Mehrdad Pahlevani

Introduction: Intracranial aneurysms (IAs) are focal dilatations of cerebral arteries that carry a significant risk of rupture and subarachnoid hemorrhage (aSAH). Advances in basic science have improved understanding of vascular wall biology, hemodynamic stress, inflammation, and genetic contribution to aneurysm rupture. Rapid progress in neurovascular therapeutics highlights the need to evaluate emerging molecular and pharmacologic strategies targeting IAs. Methodology: This narrative review synthesizes evidence from 2015 to 2025 on the cellular, molecular, and biomechanical mechanisms underlying IA pathophysiology. A structured search of PubMed, Scopus, and Embase identified studies examining molecular pathways, genetic determinants, and therapeutic approaches. Discussion: Aneurysm initiation involves endothelial responses to abnormal shear stress, activating NF-κB, MAPK, and calcium-dependent pathways that promote inflammation, smooth-muscle cell apoptosis, and extracellular matrix degradation. Pharmacologic candidates including MCP-1 antagonists, PPARγ agonists, and IL-6/STAT3 inhibitors reduce inflammatory remodeling, while doxycycline and cathepsin inhibitors preserve matrix integrity. Emerging strategies like microRNA modulation, tyrosine-kinase inhibition, and gene-based delivery offer potential for localized, durable stabilization with minimal systemic toxicity. Conclusions: Integrating surgical and biologic therapies may shift IA management from reactive repair to rupture prevention.

Journal of Vascular Diseases doi: 10.3390/jvd5020014

Authors: Brianna Wheelock Kaylyn Ly Sierra Slepicka Natalya Tasevski Amanda Perkins-Ball Deanna J. Schmidt Deborah L. Feairheller

Background: Load carriage is an essential part of the occupational work of many jobs, yet there is little research on the hemodynamic responses to load carriage. It is known that front load carriage elicits larger increases in arterial stiffness than load carried on the side of the body. However, the hemodynamic forward and reflected pulse wave responses to load carriage are unknown and could relate to cardiac risk. Methods: We compared responses to 30 s front load carriage between 45 females and 23 males, with pre- and post-carry hemodynamics assessed using pulse wave analysis. Results: We found increases (p < 0.001) in arterial stiffness (24.8% females; 32.4% males), forward pulse wave (5.8 mmHg females; 5.7 mmHg males), and reflected pulse wave (6.8 mmHg females; 9.9 mmHg males). Pre- and post-carriage forward and reflected pulse waves were lower in females (p < 0.05). Compared to males, females overall had more relationships between the change in vascular measurements and other variables. We found an inverse relationship between changes in myocardial supply–demand (SEVR) and changes in forward pulse wave in females (r = −0.37, p < 0.001) but not males. Also, a direct relationship between changes in SEVR and changes in aortic DBP (r = 0.30, p = 0.04) and changes in resting DBP (r = 0.35, p = 0.02) existed in females. Conclusions: The data suggest that sex-related differences in hemodynamic responses exist. Females may experience a larger drop in estimated myocardial supply–demand balance accompanied by lower diastolic filling. Employers should be aware of these inherent cardiac risks with load carriage in their female employees.

Journal of Vascular Diseases doi: 10.3390/jvd5020013

Authors: Brenda Hranec Luke Hudson Sophia Kermet Meghana Bomma Madison Patrick Matthew Lawson Narlin Beaty

Background/Objectives: Aneurysms develop secondary to progressive weakening of arterial walls and remain a major cause of morbidity and mortality worldwide. Collagen, particularly fibrillar types I and III, is the primary tensile load-bearing component of arteries, yet its specific role in aneurysm formation, progression, and rupture is incompletely defined. This narrative review synthesizes current evidence on collagen structure, regulation, and degradation in aneurysm pathophysiology, highlighting cerebral aneurysms within the broader context of aneurysms as a whole. Methods: Searches of PubMed, MEDLINE, Embase, and Google Scholar were performed to identify all English-language studies published prior to January 2026. Search terms included “cerebral aneurysm”, “collagen”, “extracellular matrix”, “vascular remodeling”, and “aneurysm rupture”. Included studies evaluated collagen structure or content, extracellular matrix remodeling, matrix metalloproteinases, or biomechanical properties of the aneurysm wall in experimental or human models. Results: The literature search identified 348 records, of which 87 studies published between 1999 and 2025 met the inclusion criteria and were synthesized in this review. Collagen types I and III form the primary tensile scaffold of intracranial arteries, while basement membrane and regulatory collagens (e.g., types IV, V, and VI) modulate fibril organization, endothelial stability, and mechanical homeostasis. Research demonstrates that endothelial dysfunction, nitric oxide dysregulation, oxidative stress, and matrix metalloproteinase activation are key pathways driving collagen fragmentation and degradation. Genetic and epigenetic disturbances in collagen and related extracellular matrix pathways further increase aneurysm susceptibility. Conclusions: Collagen dysregulation appears to be a final common pathway through which hemodynamic, inflammatory, hormonal, and genetic insults converge to weaken intracranial arterial walls. However, existing evidence is dominated by animal and aortic models, and in vivo tools, such as Magnetic Resonance Imaging with collagen-sensitive sequences and Positron Emission Tomography Tracers, to quantify collagen integrity in cerebral aneurysms are lacking. Future efforts should prioritize human-focused studies, advanced collagen-sensitive imaging, biomarker development, and targeted strategies to preserve or restore collagen structure as potential means to improve aneurysm risk stratification, prevention, and treatment.

Journal of Vascular Diseases doi: 10.3390/jvd5020012

Authors: Edna N. Matjuda Benedicta N. Nkeh-Chungag Godwill A. Engwa Constance R. Sewani-Rusike Nontsikelelo C. Gubu-Ntaba Charles B. Businge Adam Saloň Patrick De Boever Nandu Goswami

Background: Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are known to be involved in cardiovascular disease development. They act alongside systemic risk factors, which interact with both macrovascular and microvascular vessels to accelerate vascular damage. Therefore, the aim of this study was to investigate the cardiovascular risk factors and their relationship with retinal microvascular function in HIV-positive pregnant women on ART in Mthatha, South Africa. Methods: A cross-sectional study was carried out among 78 pregnant women (25 HIV-positive and 53 HIV-negative) in Mthatha, South Africa. Blood pressure (BP) parameters, including systolic BP (SBP), diastolic BP (DBP), and heart rate (HR), were measured, and mean arterial pressure (MAP) was calculated. Lipid profile parameters and fasting blood glucose were assessed. Markers for kidney function, such as albuminuria, were determined. Vascular biomarkers including asymmetric dimethyl arginine (ADMA) and human endothelial specific molecule-1 were quantified. Non-invasive vascular function parameters such as flow-mediated slowing (FMS), carotid-femoral pulse wave velocity (cfPWV), ankle-brachial index, central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), arteriolar venular ratio (AVR), uterine artery pulsatile index (UtA PI) were determined. Results: Diastolic BP, MAP, cfPWV, ADMA, low density lipoprotein (LDL-c) and UtA PI were higher in the HIV-positive group (p ≤ 0.05) compared to the HIV-negative group. The prevalence of prehypertension/hypertension was higher in the HIV-positive group (p ≤ 0.05). DBP, MAP, and cfPWV correlated positively with CRVE in the HIV-positive group (p ≤ 0.05), while AVR negatively correlated with the urinary creatinine (uCr) in the same group (p ≤ 0.05). Linear regression results demonstrated that DBP, cfPWV, ABI, and LDL-c were predictors of reduced AVR in the HIV-positive group. Conclusions: Increased cardiovascular risk was observed in HIV-positive pregnant women on ART. Further, increased cardiovascular risk such as hypertension and endothelial dysfunction due to ART predicted retinal microvascular dysfunction in the HIV-positive population. This implies a potential mechanistic link between macrovascular dysfunction due to cardiovascular risk factors and retinal microvascular impairment, highlighting the importance of assessing cardiovascular risk early and preserving overall vascular health in HIV-positive population.

Journal of Vascular Diseases doi: 10.3390/jvd5020011

Authors: Matthew Fynn Milan Marocchi Javed Rashid Yue Rong Goutam Saha Kayapanda Mandana

Background: Cardiovascular disease (CVD) remains the leading cause of death and disability worldwide. Among its subtypes, coronary artery disease (CAD) is the most common and often develops silently, without noticeable symptoms. CAD-related murmurs typically fall below the human hearing threshold, limiting the effectiveness of traditional stethoscope-based auscultation. Currently, the gold standard for CAD diagnosis is coronary angiography, an invasive and expensive procedure usually reserved for symptomatic patients. This highlights the global need for a non-invasive, cost-effective pre-screening tool for asymptomatic CAD detection. Objectives: This study investigates the effectiveness of a wearable vest equipped with multiple digital stethoscopes to detect CAD. By applying signal processing and machine learning to multichannel phonocardiogram (PCG) data, we aim to evaluate the accuracy of CAD detection. We further assess the impact of incorporating patient metadata to enhance model performance. Methods: Data were collected from 40 CAD patients and 40 non-CAD individuals using a wearable vest with seven embedded PCG sensors. Subjects performed 10 s breath-hold recordings in a clinical setting. Linear-frequency cepstral coefficients were extracted from the PCG signals and classified using a support vector machine. Metadata, including body mass index, blood pressure, type 2 diabetes, and hypertension, were integrated to assess performance gains. Results: A combination of four channels achieved an accuracy of 80.44%, a 7% improvement over the best single-channel result. Incorporating metadata increased accuracy to 82.08%. Conclusions: The wearable vest demonstrated promising clinical potential, exceeding a 75% sensitivity-specificity average, and may support accessible, automated CAD screening in future validated settings.

Journal of Vascular Diseases doi: 10.3390/jvd5010010

Authors: Matthew Anderson Leilei Zhang Mario Figueroa Victoria Mattia Alexander Rovner Vinitha Uppalapati Ying Xiong Rupak Mukherjee Jeffrey A. Jones Jean Marie Ruddy

Background/Objective: Activity of SGK-1 has been associated with mechanical aspects of vascular remodeling and matrix stiffening has been a known characteristic of AAA. We hypothesis that VSMC-specific SGK-1 activity is vital to growth of AAA and contributes to progressive aortic stiffness. Methods: C57Bl/6 and SMC-SGK-1KO+/− mice underwent AAA induction vs Sham on day 0. A subset of C57Bl/6 mice had pump implantation to treat with EMD638683. Aortic ultrasound images were obtained on Day 0 and Day 21 and analyzed for mechanical parameters. At terminal procedure the infrarenal aorta was harvested for immunoblot analysis. Results: At Day 21, C57Bl/6+AAA mice showed growth of 72.27% ± 2.2% versus the C57Bl/6+Sham (p < 0.0001) with associated 3.71 ± 1.15-fold increase in SGK-1 activity (p = 0.001). C57Bl/6+AAA+EMD mice demonstrated growth of 23.68% ± 2.82% (p = 0.0452) with no significant change in SGK-1 activity. SMC-SGK1-KO+/−+AAA mice had growth of 28.20% ± 3.74% compared to SMC-SGK1-KO+/−+Sham (p = 0.004) with increased SGK-1 activity (p = 0.0303). Radial strain was significantly reduced in the C57Bl/6+AAA (p = 0.0062) and C57Bl/6+AAA+EMD (p = 0.0135) when compared to C57Bl/6+Sham. Distensibility was significantly reduced in C57Bl/6+AAA (p = 0.01). Pulse propagation velocity (PPV) was significantly elevated in C57Bl/6+AAA mice (p < 0.0001) but inhibited by EMD therapy (p = 0.0007 vs. C57Bl/6+AAA). SMC-SGK1-KO+/− +AAA mice showed significant reductions in radial strain (p = 0.0011) and distensibility (p = 0.0233) with a modest, but significant, increase in PPV (p = 0.0148). Conclusions: SGK-1 inhibition attenuated AAA growth and preserved vascular function. Targeting this pathway may provide a directed medical therapy for AAA and warrants further investigation.

Journal of Vascular Diseases doi: 10.3390/jvd5010009

Authors: Jacob Alejandro Strouse Carlota Gimenez Lynch Danyas Sarathy Brandon Lucke-Wold

The Middle Meningeal Artery (MMA) occupies a pivotal role in the pathophysiology of migraine, functioning as a vascular and neuroimmune interface that precipitates the characteristic pulsatile pain. The inhibition of this pathophysiological cascade has been investigated as a therapeutic strategy. However, fewer than a dozen centers globally have disseminated procedural or mechanistic data. Given the nascency of this field and the imperative for standardization, the present review synthesizes mechanistic and clinical evidence underpinning intra-arterial pharmacological modulation of the MMA for migraine management. Methods: A focused narrative review was undertaken, drawing upon select but influential studies from pioneering research groups investigating intra-arterial interventions targeting the MMA. The extant literature was thematically categorized and organized according to the loci of cascade interruption and their corresponding clinical outcomes. Results: Since 2009, intra-arterial therapies for severe headache syndromes have evolved, initially utilizing nimodipine for vasospasm-related headaches, progressing to verapamil for reversible cerebral vasoconstriction, and more recently, lidocaine for refractory or status migrainosus, occasionally in conjunction with MMA embolization. Contemporary research uses language that conceptualizes migraine as an immunologically mediated neurovascular disorder, as opposed to a purely vascular or neuronal entity. Recent investigations have identified interleukins such as Interleukin-1β, Tumor Necrosis Factor-α, and Interleukin-6 as critical amplifiers of trigeminovascular activation. Purinergic signaling through the P2X3 receptor and the P2Y13 receptor, in conjunction with pituitary adenylate cyclase-activating polypeptide and vasoactive intestinal peptide pathways, has been implicated in the modulation of MMA excitability and neuropeptide release. The development of novel calcitonin gene-related peptide receptor antagonists, such as zavegepant, further substantiates the artery’s significance as a pharmacological target. Conclusions: These findings support a shift toward immune-modulating intra-arterial therapeutic strategies, with migraine interventions targeting cytokine and neuroimmune signaling within the MMA, rather than relying exclusively on vasodilatory mechanisms.

Journal of Vascular Diseases doi: 10.3390/jvd5010008

Authors: Marco Pasetto Alessandro Russo Lorenzo Peluso Marcello Ceola Graziadei Leonardo Gottin

Ventricular–arterial coupling (VAC) describes the dynamic interaction between left ventricular (LV) systolic elastance and the time-varying elastance/impedance of the arterial tree, a relationship that governs the instantaneous generation of aortic flow and ultimately cardiac output. VAC, typically expressed as the ratio of effective arterial elastance (Ea) to LV end-systolic elastance (Ees), has provided valuable mechanistic and prognostic insights, but is limited by its lumped, largely steady-state nature and by the need for pressure–volume modeling or complex surrogate formulas. Contemporary time-domain and wave-intensity approaches have underscored that the shape of proximal aortic pressure–flow waveforms encodes rich beat-by-beat information about ventricular–arterial interaction and energy transfer. Doppler echocardiography of the ascending aorta provides a readily available, high-temporal resolution measure of proximal aortic flow that is already used to quantify stroke volume, cardiac output and valvular lesions. We propose that proximal aortic flow, as recorded by Doppler echocardiography, may serve as a clinically practical proxy for beat-by-beat VAC, reflecting the instantaneous matching of ventricular and aortic elastances, which regulates the ejected flow towards peripheral tissues according to metabolic needs.

Journal of Vascular Diseases doi: 10.3390/jvd5010007

Authors: Shahzad G. Raja

Off-pump coronary artery bypass grafting (OPCAB) represents one of the most significant technical innovations in contemporary cardiac surgery. Developed as an alternative to conventional on-pump coronary artery bypass grafting (ONCAB), OPCAB avoids cardiopulmonary bypass and its associated systemic inflammatory response, aiming to reduce perioperative morbidity and improve recovery. Over the past three decades, advances in stabilization devices, intracoronary shunts, anesthetic management, and surgical training have refined the procedure, making it safer and more reproducible. Despite these developments, OPCAB adoption remains inconsistent worldwide, reflecting ongoing debate about its relative benefits and limitations. Evidence from randomized controlled trials, meta-analyses, and large registries suggests that OPCAB achieves comparable early mortality to ONCAB, with potential advantages in reducing renal dysfunction, neurocognitive decline, and perioperative bleeding. These benefits appear most pronounced in high-risk subgroups, including elderly patients and those with significant comorbidities. However, concerns persist regarding long-term graft patency, completeness of revascularization, and variability in outcomes depending on surgeon experience and institutional expertise. Cost-effectiveness analyses have suggested potential resource savings, but these are offset by training requirements and the technical complexity of the procedure. Global practice variation highlights the influence of surgical culture, guideline ambiguity, and institutional resources. Barriers to universal adoption include technical challenges, inconsistent long-term outcomes, and limited exposure in training programs. In the future, robotic and minimally invasive OPCAB, as well as hybrid revascularization strategies, may expand its role. This review synthesizes current evidence, explores barriers to widespread implementation, and outlines future directions for integrating OPCAB into balanced, evidence-based clinical practice.

Journal of Vascular Diseases doi: 10.3390/jvd5010006

Authors: Abhay Setia Roberto Scaratti Maher Fattoum Samir Khan Farzin Adili

Background: We present our experience of carrying out endovascular therapy (EVT) of a pseudo-aneurysm of the posterior tibial artery (PTA) with an associated arteriovenous fistula (AVF). We also present results of a systematic review which was carried out to cast light on endovascular treatment modalities. Methods: A 31-year-old patient with a history of war trauma presented with pain of increasing severity in the lower leg. A CT angiogram confirmed an aneurysm of the PTA with an AVF. With a bidirectional endovascular approach, the aneurysm was occluded with coils and excluded with a Viabahn endoprosthesis. Aspirin and clopidogrel were recommended postoperatively. After 18 months of follow-up, the patient was free of symptoms, with patent endoprosthesis. Multiple databases (Scopus, Pubmed, Medline, OVID) were systematically searched using MeSH terms. The studies were scrutinized, and data on demographics, procedural details, and follow-up were collected and aggregated. Results: A total of 44 studies (56 patients) were eligible and were included. Average age was 50 (15–87 years). The most common etiology was trauma (iatrogenic 29/56 (51.7%); non-iatrogenic 15/56 (26.7%)). EVT strategies included coil embolization (n = 29), stent implantation (n = 25), and a combination of both (n = 2). Median stent diameter was 3 mm (2.5–6). The follow-up period ranged from 1 week to 60 months. Aggregated reported primary patency was 18/27 (66.6%) with no documented complications—an observation that likely reflects reporting and publication bias, rather than a true absence of adverse events. Conclusions: EVT offers a feasible and safe alternative to simple ligation or occlusion of crural aneurysms, to preserve distal flow to the foot. Dedicated stents for crural arteries are not available. Studies with long-term follow-up are lacking.

Journal of Vascular Diseases doi: 10.3390/jvd5010005

Authors: Davide Costa Raffaele Serra

Vascular diseases remain a major global health burden despite remarkable technological advances in vascular surgery and endovascular therapies. Conditions such as peripheral arterial disease, abdominal aortic aneurysm, carotid stenosis, chronic venous disease, diabetic vasculopathies, and vascular chronic ulcers are not only biological entities but are deeply shaped by social structures, cultural norms, and economic inequalities. This article introduces Vascular Sociology as an interdisciplinary field that integrates vascular surgery with medical sociology to provide a more comprehensive understanding of vascular health and disease. Drawing on classical and contemporary sociological theory, including concepts such as social determinants of health, embodiment, illness narratives, and the disease–illness–sickness triad, the article argues that vascular pathology reflects cumulative social exposures across the life course. Socially patterned behaviors, work conditions, food environments, healthcare access, gender norms, and geographic inequalities profoundly influence disease onset, progression, treatment decisions, and outcomes. The paper highlights how surgical success is contingent not only on technical excellence but also on patients’ social contexts, including health literacy, trust in institutions, caregiving resources, and the capacity to adhere to long-term follow-up and rehabilitation. By outlining conceptual foundations, epidemiological evidence, and mixed-methods research strategies, the article positions Vascular Sociology as a framework capable of bridging biomedical knowledge with lived experience. This approach expands the definition of vascular outcomes to include social reintegration, identity transformation, and equity of care, ultimately aiming to improve patient-centered practice, reduce disparities, and inform more socially responsive vascular health policies.

Journal of Vascular Diseases doi: 10.3390/jvd5010004

Authors: Niccolò Fagni Ludovica Livi Federico Bucciarelli Francesco Ruben Giardino Roberto Cuomo Ferdinando Paternostro Immacolata Belviso Jacopo Junio Valerio Branca

Introduction: Accurate knowledge of the external carotid artery (ECA) anatomy is essential for head and neck surgery, interventional procedures, and imaging interpretation. Although its branching pattern is classically described as relatively constant, clinically relevant anatomical variations are frequently encountered. Cadaveric dissection remains fundamental for identifying rare vascular configurations. Materials and Methods: During an anatomical teaching dissection of a 72-year-old male cadaver, a right-sided lateral cervicotomy was performed to expose the carotid sheath. After mobilisation of the sternocleidomastoid muscle, the ECA and its proximal branches were skeletonised, allowing detailed three-dimensional assessment of their origin, calibre, and neurovascular relationships. Results: The superior thyroid artery originated from the proximal segment of the external carotid artery, in close proximity to the carotid bifurcation. The main anatomical finding was a lingual artery of relatively small initial calibre exhibiting an atypical superior trajectory: after its origin, it crossed superior to the hypoglossal nerve before continuing toward the tongue. This configuration differs from classical descriptions and modified the anatomical arrangement of Beclard’s and Pirogoff’s triangles, creating a potential site of close neurovascular contact. Conclusions: This cadaveric study describes a rare trajectory-based variant of the external carotid artery characterised by a lingual artery crossing superior to the hypoglossal nerve. Awareness of such rare patterns is essential for improving anatomical interpretation and enhancing surgical safety in the head and neck region.

Journal of Vascular Diseases doi: 10.3390/jvd5010003

Authors: Masashi Tawa Keisuke Nakagawa Mamoru Ohkita

Background/Objectives: Vascular calcification is a major contributor to cardiovascular mortality and disability. Here, we investigated whether dietary nitrate, an exogenous source of nitric oxide (NO), could inhibit vascular calcification in a rat model induced by excess vitamin D3. Methods: The rats were injected subcutaneously with phosphate-buffered saline or 200,000 IU/kg cholecalciferol and the abdominal aorta was isolated 7 and 14 d after injection. Results: Von Kossa staining revealed mild vascular calcification 7 d after injection, with the positive area expanding by 14 d. Vasorelaxation induced by the NO donor sodium nitroprusside was normal 7 d after injection but weakened 14 d after injection. In a separate experiment, sodium nitrate (3 or 10 mM in drinking water) was administered for the last 7 and 13 d, prior to sacrifice, 14 d after cholecalciferol injection. Von Kossa staining-positive areas and calcium content in the abdominal aortas did not decrease with short-term administration of sodium nitrate but decreased with long-term administration; no difference in effect based on dosage was observed in either short-term or long-term administration. Low-dose sodium nitrate tended to increase plasma nitrite and nitrate levels, which are indicators of NO bioavailability, similar to both short- and long-term administration, which increased significantly at higher doses. Conclusions: These findings suggest that NO homeostasis in blood vessels deteriorates with the progression of vascular calcification, and that dietary nitrate may be a useful therapeutic approach.

Journal of Vascular Diseases doi: 10.3390/jvd5010002

Authors: Ali Kordzadeh Karen May Rhodes

Background: Type B Aortic Dissection (TBAD) management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in National Health Services (NHSs). Bridging the gap between Emergency Medicine (EM) and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improve outcomes and reduce mortality. Methods: A cross-sectional survey of EM consultants yielded n = 173 valid responses from n = 33 units across the UK. Subgroup analyses were conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland–Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to a rapid Computed Tomography Angiogram (CTA) was 70% (95% CI: 63.3–76.8%, p < 0.001), while 32% had standard operating procedures (SOPs) for TBAD (95% CI: 25.3–39.1%), and 26% were aware of any decision tool (95% CI: 20.6–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with a reported bias of 23.58% (−38.20% to 85.36%) (p = 0.02). Conclusions: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks. Furthermore, upon recognition of the most prevalent factors, CTA and specialist referral is advocated.

Journal of Vascular Diseases doi: 10.3390/jvd5010001

Authors: Enes Demir Deondra Montgomery Henry Freeman Maryam Zeinali Denise Baloi Brandon Lucke-Wold Michael Karsy

Background: Intracranial atherosclerotic disease (ICAD) remains a major global cause of ischemic stroke—particularly in Asian, Black, and Hispanic populations—and is characterized by high recurrence rates despite advances in intensive medical management. Objectives: This review synthesizes current evidence on surgical and endovascular approaches for ICAD, including extracranial–intracranial bypass, encephaloduroarteriosynangiosis, angioplasty, and hybrid revascularization strategies. Methods: We performed a structured narrative literature search of PubMed and Scopus. Searches were conducted up to 1 October 2025 using combinations of subject headings and keywords, including “intracranial atherosclerotic disease”, “ICAD”, “intracranial stenosis”, “bypass”, “encephaloduroarteriosynangiosis”, “angioplasty”, “stenting”, “revascularization”, and “stroke”. We also scanned reference lists of key articles and relevant reviews. Non-English language articles were excluded. Results: While randomized trials such as SAMMPRIS, VISSIT, and CASSISS reaffirm intensive medical management as first-line therapy, emerging data suggest that surgical revascularization may benefit select patients with hemodynamic compromise refractory to medical therapy. Recent studies incorporating physiologic imaging—such as PET, SPECT, and perfusion MRI—have refined patient selection, reducing perioperative risk and improving long-term outcomes. Innovations in indirect revascularization, hybrid procedures, and intraoperative imaging continue to expand therapeutic possibilities. However, evidence remains heterogeneous, underscoring the need for well-powered randomized trials integrating modern surgical techniques, objective hemodynamic endpoints, and AI-enhanced imaging analytics. Conclusions: While intensive medical management remains the first-line standard of care, select patients with refractory, hemodynamically significant ICAD may benefit from direct, indirect, or hybrid surgical revascularization. Future directions emphasize personalized, physiology-based management frameworks that combine medical, surgical, and technological advances to optimize stroke prevention and long-term vascular outcomes in ICAD.

Journal of Vascular Diseases doi: 10.3390/jvd4040052

Authors: Andrea Buono Paolo Alberto Del Sole Andrea Zito Barbara Bellini Nicholas Montarello Abdul Amir Samuel Sossalla Chiara De Biase Giuliano Costa Tommaso Fabris Mauro Massussi Giulia Costa Riccardo Gorla Michele Bellamoli Angela McInerney Victoria Vilalta Mario Garcia Gomez Marco Gennari Enrico Giacomin Gabriele Tumminello Claudio Montalto Andrea Scotti Greta Cattaneo Antonio Giovanni Cammardella Mariano Pellicano Michele Galasso Mauro Gitto Nawzad Saleh Matthias Renker Claudio Sanfilippo Antonio Messina Pier Pasquale Leone Emiliano Bianchini Giovanni Esposito Carlo Trani Francesco Saia Alfonso Ielasi Ady Orbach Mao Chen Stefano Carugo Raj R. Makkar Azeem Latib Helge Möllmann Francesco Soriano Luca Favero Antonio Mangieri Federico De Marco Marianna Adamo Xavier Carrillo Suarez Marco De Carlo Ignacio Amat-Santos Diego Maffeo Francesco Bedogni Marco Barbanti Francesco Burzotta Daniel J. Blackman Didier Tchètchè Ole De Backer Giuseppe Tarantini Matteo Montorfano Andreas Rück Won-Keun Kim Darren Mylotte

Background: Self-expanding transcatheter heart valves (SEVs) are often used to treat Sievers type 1 bicuspid aortic valve (BAV) stenosis. It remains unclear, however, if different SEVs yield similar outcomes in BAV stenosis, a class effect, or if the unique design features of different SEVs produce disparate clinical results. Objectives: This is a “proof-of-concept” study that compares procedural and clinical outcomes of Acurate neo2 and Evolut Pro/Pro+/Fx platforms in Sievers type 1 BAV stenosis. Methods: The CLASS effect is a retrospective, multicenter registry that enrolls patients with raphe-type 1 BAV stenosis undergoing TAVI at 29 international centers, who received Acurate neo2 and Evolut Pro/Pro+/Fx devices. An inverse probability of treatment weighting (IPTW) analysis was performed to adjust for baseline imbalances. Primary endpoints included VARC-3 technical success, 30-day device success, and early safety according to VARC-3. Results: Among 389 eligible patients, 155 and 234 patients were treated with Acurate neo2 and Evolut platforms, respectively. A higher rate of technical success was observed in the Evolut group (Acurate neo2 vs. Evolut: 93.4% vs. 97.1%, OR 0.41, 95% CI 0.19–0.83, and p = 0.017). At 30 days, device success was comparable (90.1% vs. 89.4%, OR 1.09, 95% CI 0.68–1.75, and p = 0.733), whereas Acurate neo2 was associated with a higher rate of early safety (84.1% vs. 70.4%, OR 2.22, 95% CI 1.56–3.17, and p < 0.001), which was mainly driven by a lower risk of new permanent pacemaker implantation (PPI) (6.3% vs. 19.5%, OR 0.28, 95% CI 0.16–0.46, and p < 0.001). Conclusions: Acurate neo2 and Evolut Pro/Pro+/Fx platforms provide similarly effective procedural and short-term outcomes in Sievers type 1 BAV stenosis. However, Evolut was associated with a higher technical success, while Acurate neo2 demonstrated a lower incidence of new PPI.

Journal of Vascular Diseases doi: 10.3390/jvd4040051

Authors: Samantha Stauffer Ryan Pohlig Frank Sarlo John Horne Jaclyn Sions

Objectives: This study aimed to identify factors associated with mean arterial pressure and pulse pressure, while considering non-modifiable factors. Methods: This study was a retrospective cross-sectional analysis of adults with lower limb loss and no history of a major adverse cardiovascular event. Participants completed self-reported medical histories and outcome measures, including a report of pain extent per body diagrams and physical activity per the General Practice Physical Activity Questionnaire. During an onsite clinical evaluation, participants underwent a resting vital sign assessment by a physiatrist and/or physical therapist. Forward stepwise logistic regression models were run to identify the factors associated with elevated mean arterial pressure (i.e., >100 mmHg) and wide pulse pressures (i.e., >60 mmHg). Results: Of 206 participants (aged 54.5 ± 14.1 years; 74.3% male; 72.8% White; 42.2%; dysvascular etiology), n = 107 (51.9%) presented with an elevated mean arterial pressure and n = 52 (25.2%) had a wide pulse pressure. Forty-two participants (20.4%) presented to the clinic with both conditions. A mean arterial pressure > 100 mmHg was associated with upper extremity pain presence [odds ratio (OR) = 2.62, 95% confidence interval (CI) = 1.26–5.45, p = 0.010] and increasing heart rate (OR = 1.02, CI = 1.00–1.04, p = 0.033). A pulse pressure > 60 mmHg was associated with advancing age (OR = 1.07, 95%CI = 1.04–1.10, p < 0.001) and a lower physical activity level (OR = 1.50, 95%CI = 1.07–2.11, p = 0.017). Conclusions: Over 50% of adults with lower limb loss and no history of major adverse cardiovascular events have an elevated mean arterial pressure and/or wide pulse pressure, suggesting maladaptive cardiovascular changes. Factors associated with elevated mean arterial pressure and/or wide pulse pressure may suggest underlying cardiovascular disease and sympathetic overactivity, warranting a further evaluation of cardiovascular risk.

Journal of Vascular Diseases doi: 10.3390/jvd4040050

Authors: Živojin S. Jonjev

Background: Despite level-A evidence demonstrating superior long-term survival with bilateral internal mammary artery (BIMA) grafting, its global utilization remains dismally low (<10–15%), largely due to historical concerns over deep sternal wound infections (DSWI) and technical complexity. This underutilization persists even as multi-arterial grafting (MAG) adoption stagnates, with recent North American data showing only 16% of coronary artery bypass grafting CABG procedures utilize more than one arterial conduit. Objective: This review synthesizes contemporary evidence demonstrating that modern surgical refinements—particularly skeletonized “no-touch” harvesting—have effectively mitigated these concerns, enabling wider BIMA application. Methods & Results: Over two decades of institutional experience confirm that skeletonized harvesting preserves sternal perfusion and minimizes DSWI risk, even in high-risk patients. Propensity-matched analyses show significant survival benefits of BIMA grafting across age and comorbidity strata (8-year survival: 67.1% BIMA vs. 58.2% single internal mammary artery (SIMA), p < 0.05), rendering previous contraindications relative rather than absolute. Long-term outcomes demonstrate superior 10-year survival for in situ BIMA compared with SIMA (86.1% vs. 78.6%, p < 0.05). Advanced configurations such as sequential skeletonized grafting are safe and further enhance outcomes. In single-vessel left anterior descending artery (LAD) disease, skeletonized left internal mammary artery (LIMA) continues to outperform percutaneous coronary intervention (PCI), underscoring the unmatched durability of arterial conduits. Conclusions: The technical evolution of conduit harvesting has resolved the “BIMA paradox”. Contemporary evidence supports BIMA grafting as a standard of care for a broad CABG population, offering a durable, lifelong solution for coronary artery disease and warranting renewed guideline emphasis on multi-arterial revascularization.

Journal of Vascular Diseases doi: 10.3390/jvd4040048

Authors: Luis E. Fernández-Garza Valeria A. Fernández-Garza Daniela Mares-Custodio Victor Gutiérrez-Ruano Alexandro Navarrete-Rodríguez Juan J. Arias-Alzate

Subarachnoid hemorrhage (SAH) is a life-threatening cerebrovascular event with high mortality and long-term morbidity. While clinical grading scales such as Hunt and Hess or the World Federation of Neurological Surgeons (WFNS) score aid in prognosis, their accuracy implies a neurological assessment that can be confounded in sedated patients, highlighting the need for objective biomarkers. Biomarkers offer an alternative approach for risk stratification. This review examines the prognostic value of the glucose/potassium ratio (GPR) in patients with aneurysmal SAH and its potential integration into future predictive models. A literature review of retrospective studies assessing the association between GPR and clinical outcomes in SAH was conducted. Evidence on the pathophysiological basis of stress-induced hyperglycemia and hypokalemia in SAH is presented, along with findings from five key clinical studies evaluating GPR in relation to mortality, vasospasm, delayed cerebral ischemia, and functional outcomes. Elevated GPR levels were consistently associated with poor short- and long-term outcomes in SAH patients. Studies reported significant correlations between GPR and 30-day mortality, poor Glasgow Outcome Scale (GOS) scores, increased incidence of cerebral vasospasm, and higher rates of rebleeding. The optimal GPR cutoff for predicting adverse outcomes was greater than 37 mg/dL, with multivariate analyses confirming GPR as an independent prognostic factor. GPR is a promising, cost-effective biomarker that integrates two stress-response parameters (glucose and potassium), both of which are independently associated with SAH prognosis. Its incorporation into future predictive models may enhance early risk stratification and guide clinical decision-making. Further prospective studies are warranted to validate its utility and standardize its clinical application.

Journal of Vascular Diseases doi: 10.3390/jvd4040049

Authors: Danish Yar Eran Wen Jun Sim Bernard Wong Sarah Fairley Cuneyt Ada George Touma Bharat Khialani

Intramural hematoma (IMH) is an infrequent but clinically significant complication of percutaneous coronary intervention (PCI), characterized by blood accumulation within the medial layer, causing true lumen compression and impaired coronary flow. Often under-recognized on angiography, the use of intravascular imaging has enhanced diagnostic accuracy and facilitated timely management. This review outlines the pathophysiology and mechanisms of iatrogenic IMH during PCI, clinical presentations, and contemporary strategies for detection and treatment. Illustrative case examples highlight practical considerations. We discuss the roles of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared imaging in diagnosis; summarize interventional approaches including stenting, cutting/scoring balloons, and drug-coated balloons; and propose a pragmatic clinical management algorithm. This reinforces that early identification of PCI-related IMH coupled with imaging-directed therapy significantly improves procedural accuracy and correlates with more favorable long-term vascular outcomes.

Journal of Vascular Diseases doi: 10.3390/jvd4040047

Authors: Angelo Santoliquido Teresa Lucia Aloi Marcello Izzo Giuseppe Camporese

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.

Journal of Vascular Diseases doi: 10.3390/jvd4040046

Authors: Min Ji Son Seung Min Yoo Hwa Yeon Lee Charles S. White

Objectives: The field of view on abdominal CT includes the lower portion of the heart and thoracic aorta. Notably, triple rule-out (TRO) abnormalities [acute myocardial infarction (AMI), acute aortic syndrome (AAS), and pulmonary thromboembolism (PE)] may be overlooked on abdominal CT. The purpose of this paper is to evaluate the frequency of overlooked TRO abnormalities on abdominal CT in patients presenting with nonspecific abdominal pain. Methods: We retrospectively identified 913 patients from January 2017 to June 2018 in whom enhanced abdominal CT was performed due to nonspecific abdominal pain. Two chest radiologists retrospectively assessed the abdominal CT, focusing on whether TRO abnormalities were overlooked. Results: Upon retrospective review, there were 0.5% TRO abnormalities (four AMI and one AAS) not described on abdominal CT. A majority (71.4%) of the TRO abnormalities were overlooked on the initial CT report. Conclusions: Radiologists should routinely assess the lower chest on abdominal CT to avoid overlooked TRO abnormalities.

Journal of Vascular Diseases doi: 10.3390/jvd4040045

Authors: Lara Vasari Vedrana Mužić Sandra Marinović Kulišić Daška Štulhofer Buzina Endi Radović Ana Lamza

Chronic venous insufficiency (CVI) is a common peripheral vascular condition characterised by the retrograde blood flow in the lower extremities and its consequences such as oedema and other complications. Clinical severity of CVI is assessed according to the CEAP (Clinical, Etiological, Anatomic, and Physiopathologic) classification, which recognises seven grades of increasing clinical severity (C0–C6). Compression therapy aims to accelerate vein, lymph, and microcirculation flow and therefore reduce chronic nonbacterial inflammation and oedema of the extremities. In accordance with the elasticity and stiffness, compression bandages and garments are divided into short-stretch and long-stretch compression materials. Compression therapy is applicable in all stages of CVI. Moreover, compression therapy in conjunction with physical therapy and lifestyle modifications is more effective in reducing oedema, preventing venous distension, and reducing venous wall tension, all while improving calf muscle pump function. Physical therapy in CVI treatment combines everyday lifestyle modifications, physical activity, medical exercise, sports activity, hydrotherapy, and electrotherapy. Therefore, physical therapy is used either for prevention or either for therapeutic purposes in CVI. For grades CEAP C0–C2, preventive measures consist of education and counselling, medical exercise and general fitness, and sports and physical activities. However, for therapy in grades CEAP C3–C6, medical exercise and a specific rehabilitation programme, manual lymphatic drainage and massage, balneotherapy, and electrotherapy are recommended.

Journal of Vascular Diseases doi: 10.3390/jvd4040044

Authors: Syed Haris Omar Md Ahsan Ghani

Alzheimer’s disease (AD), epilepsy, and vascular dementia (VaD) are highly prevalent neurological diseases and lead global drivers of morbidity. While these conditions have been historically treated as distinct entities, they now appear to share convergent molecular and cellular processes that drive disease initiation and progression. This narrative review collates evidence from studies published from 2000 to 2025 to investigate overlapping mechanisms and therapeutic opportunities for the three conditions. Five interconnected mechanisms, excitotoxicity, neuroinflammation, oxidative stress, mitochondrial dysfunction, and vascular impairment, were identified as key driving processes resulting in self-sustaining cycles leading to neuronal injury, cognitive impairment, and seizure susceptibility. Clinically, this is represented by shared cognitive, behavioral, and functional impairments, and often, seizures can be overlooked during the dementia process. Therapeutic strategies which may be useful across diseases could include anti-inflammatory treatments, mitochondrial stabilizers, vascular health treatments, and protein aggregation changes. Important translational gaps also exist for practice particularly in the biomarker space and trials that allow intervention across diseases. Each of these conditions, in essence, represent the same inter-relationships at the level of pathophysiology and provides opportunities for multi-targeted treatment approaches and integrated research trajectories to ease the worldwide burden of neurodegenerative disorder.

Journal of Vascular Diseases doi: 10.3390/jvd4040043

Authors: Dominika Żyła Katarzyna Zych Milena Krawczyk Julia Nowakowska

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu disease, is an autosomal dominant vascular disorder caused most commonly by pathogenic variants in the ENG and ACVRL1/ALK1 genes. It is characterized by mucocutaneous telangiectasias and arteriovenous malformations (AVMs) in various organs, leading to recurrent epistaxis, gastrointestinal bleeding, and iron deficiency anemia. Diagnosis relies on the Curaçao Criteria, which include recurrent nosebleeds, characteristic telangiectasias, visceral AVMs, and family history. This review aims to present current therapeutic approaches and emerging treatment strategies for HHT. Traditional surgical and laser-based methods are increasingly complemented or replaced by targeted pharmacological interventions. Antiangiogenic agents such as bevacizumab and thalidomide have demonstrated efficacy in reducing bleeding frequency and transfusion requirements, although adverse effects may limit long-term use. Novel therapies under investigation target molecular pathways involved in vascular remodeling, including tyrosine kinase inhibitors (sorafenib, nintedanib), anti-ANGPT2 antibodies, and modulators of BMP9/ALK1 signaling (tacrolimus, sirolimus). Preclinical and early clinical studies suggest that these agents may provide disease-modifying benefits. Continued research should focus on optimizing treatment efficacy, reducing toxicity, and developing individualized therapeutic regimens based on genetic and clinical characteristics.

Journal of Vascular Diseases doi: 10.3390/jvd4040042

Authors: Salma Younas Harshavardhan Parvathi Sweta Sahu Renu Rani Samiya Saher Yiannis S. Chatzizisis Maria Carolina Delgado-Lelievre

Background: Hypertension remains a leading cause of cardiovascular morbidity and mortality, disproportionately affecting low- and middle-income countries (LMICs), where healthcare access and awareness are limited. Excessive sodium intake, often from discretionary salt used in cooking, contributes significantly to this burden. Salt substitutes, typically formulated by partially replacing sodium chloride with potassium chloride or other minerals, offer a cost-effective dietary intervention to lower blood pressure (BP) and reduce cardiovascular risk, particularly in resource-constrained settings. Objective: This review examines the efficacy of low-sodium salt substitutes (LSSS) in reducing blood pressure (BP) and its effects on cardiovascular (CV) outcomes, safety concerns, and challenges to their implementation in LMICs. Methods: We conducted a comprehensive narrative review of studies published between 1994 and 2024 using PubMed, Embase, and Scopus databases. Eligible studies included randomized controlled trials, systematic reviews, observational studies, and implementation research that evaluated the effects of LSSS on BP, CV outcomes, safety, and feasibility in LMIC contexts. Thematic synthesis was used to summarize the findings. Key Findings: Salt substitutes consistently lowered systolic and diastolic BP across diverse populations, with mean reductions ranging from 3 to 5 mmHg. Trials have also demonstrated reductions in stroke incidence, CV events, and all-cause mortality. However, the benefits were mostly derived from studies conducted in China and other upper-middle-income settings. Safety concerns (particularly hyperkalemia in individuals with chronic kidney disease or RAAS inhibitors) warrant targeted risk screening and public education. Implementation barriers in LMICs include cost, limited availability, poor awareness, and a lack of regulatory oversight. Conclusions: Salt substitutes present a promising, scalable strategy to reduce BP and CV disease burden in LMICs. However, their adoption must be context-specific, culturally sensitive, and supported by government subsidies, regulatory frameworks, and educational campaigns. Future trials should evaluate the long-term safety and cost-effectiveness in underrepresented LMIC populations to guide equitable public health interventions.

Journal of Vascular Diseases doi: 10.3390/jvd4040041

Authors: Karthikeyan M. Arcot Joel Thomson Ayush Mishra Naomi Gonzales Christina Klippel Vincent S. DeOrchis

Background: Orthostatic hypotension (OH) is identified by a significant decrease in blood pressure upon standing from a seated or supine position. A reduction in systolic blood pressure of 20 mmHg within three minutes of standing meets the criteria for clinical diagnosis. We hypothesized that venous outflow obstruction from jugular valvular dysfunction or extrinsic compression of the left brachiocephalic vein may cause OH. Improving venous return and reducing venous congestion of the autonomic pathways through endovascular intervention could alleviate symptoms. Methods: This retrospective review included six male patients (aged 63–87) with medically refractory OH who underwent venograms revealing jugular, brachiocephalic, or subclavian vein stenosis. Patients were treated with balloon angioplasty and/or stenting. Blood pressure was measured in supine, seated, and standing positions before and immediately after the procedure, with multiple readings per position (total n = 117 for supine-standing comparisons). Statistical analysis used Welch’s t-test to compare pre- and post-procedural systolic blood pressure disparities. Results: The patients showed improved post-procedural blood pressure and reduced OH symptoms. The average supine-standing systolic disparity decreased from 38.68 mmHg preoperatively to 24.61 mmHg postoperatively (p = 0.024). The seated-standing disparity was insignificant, possibly due to autonomic compensation. Patients also reported relief from associated symptoms like headaches, tinnitus, and vertigo. Conclusions: These findings suggest venous outflow obstruction may contribute to OH, and venoplasty/stenting can mitigate symptoms, potentially reducing reliance on medications with adverse effects. Further studies should explore the role of Venous Outflow Obstruction Disorders in neurological conditions.

Journal of Vascular Diseases doi: 10.3390/jvd4040040

Authors: Marta Casula Michele Collareta Sergio Berti Antonio Rizza

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.

Journal of Vascular Diseases doi: 10.3390/jvd4040039

Authors: Dhruv Jain Anand Prasad Harsha Shahi Nishant Wadhera Ashish Goel Yashendra Sethi

Background: Cardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease (CKD), driven by mechanisms distinct from the general population. Fibroblast Growth Factor 23 (FGF-23), a phosphaturic hormone elevated early in CKD, has been mechanistically linked to left ventricular hypertrophy, vascular dysfunction, and disordered mineral metabolism. This study examines the associations between FGF-23 and key renal, mineral, and cardiovascular parameters and its utility in risk stratification. Methods: We conducted a cross-sectional study of 60 adults with CKD stages 1–5. Serum FGF-23 was quantified using ELISA, alongside measures of iPTH, phosphorus, calcium, and eGFR (Estimated Glomerular Filtration Rate). Cardiovascular evaluation included transthoracic echocardiography and carotid intima-media thickness (CIMT). Associations were analyzed using Spearman correlations, ROC analysis, and multivariable logistic regression. Results: FGF-23 levels were significantly associated with declining eGFR (r = –0.288; p < 0.05), elevated iPTH (Intact Parathyroid Hormone) (r = 0.361; p < 0.05), and serum phosphorus (r = 0.335; p < 0.05). Patients with structural cardiac abnormalities (left atrial enlargement or left ventricular hypertrophy) exhibited higher FGF-23 concentrations (154 vs. 128 pg/mL; p = 0.027). FGF-23 alone predicted high cardiovascular risk with moderate accuracy (AUC 0.70; sensitivity 76%; specificity 67%). A composite model including iPTH and eGFR improved discriminatory power (AUC 0.76). Conclusions: FGF-23 correlates with subclinical cardiovascular remodeling and key mineral abnormalities in CKD. Its integration with iPTH and eGFR enhances cardiovascular risk stratification, supporting its potential as a multidimensional biomarker in early CKD. However, the cross-sectional design and modest correlation strengths limit causal inference and generalizability of the findings.

Journal of Vascular Diseases doi: 10.3390/jvd4040038

Authors: A B M Nazmus Salehin Nahid Mashrur Muntasir Nuhash Ruihang Zhang

An ascending aortic aneurysm is a localized dilation of the ascending aorta, which poses a high risk of aortic dissection or rupture, with surgery recommended at diameters > 5.5 cm. However, events also occur at smaller sizes, suggesting additional factors—such as stenosis—may significantly influence aneurysm severity. To investigate this, a computational fluid dynamics (CFD) analysis was conducted using a patient-specific ascending aortic model (aneurysm diameter: 5.28 cm) under three aortic stenosis severities: mild, moderate, and severe. Results showed that the severe stenosis condition led to the formation of prominent recirculation zones and increased peak velocities, 2.36 m·s−1 compared to 1.53 m·s−1 for moderate stenosis and 1.37 m·s−1 for mild stenosis. A significantly increased pressure loss coefficient was observed for the severe case. Additionally, the wall shear stress (WSS) distribution exhibited higher values along the anterior region and lower values along the posterior region. Peak WSS values were recorded at 43.46 Pa in the severe stenosis model, compared to 21.98 Pa and 13.87 Pa for the moderate and mild cases, respectively. Velocity distribution and helicity analyses demonstrate that increasing stenosis severity amplifies jet-induced flow disturbances, contributing to larger recirculation zones and greater helicity heterogeneity in the ascending aorta. Meanwhile, WSS results indicate that greater stenosis severity is also associated with elevated WSS magnitude and heterogeneity in the ascending aorta, with severe cases exhibiting the highest value. These findings highlight the need to incorporate hemodynamic metrics, alongside traditional diameter-based criteria, into rupture risk assessment frameworks.

Journal of Vascular Diseases doi: 10.3390/jvd4030037

Authors: Ivan Privitera Luca Costanzo Paola Magnano San LIo Raffaella Romano Salvatore Piro Marcello Romano

Background: Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting large and medium-sized arteries, predominantly in individuals over 50 years. While it traditionally involves cranial branches of the external carotid artery, particularly the temporal arteries, growing evidence underscores frequent extracranial involvement, especially in the supra-aortic trunks. Objective: We aimed to critically review the diagnostic utility of extended Color Doppler Ultrasound (CDUS) in GCA, with a focus on vertebrobasilar involvement and current international imaging guidelines. Methods: Taking inspiration from a representative case of extracranial GCA with vertebrobasilar ischemic events, the current literature and international recommendations (e.g., EULAR, ACR, BSR and SIR) were reviewed. Results: Diagnostic accuracy significantly improves when CDUS is extended to include carotid, vertebral, subclavian and axillary arteries. Elevated inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) correlate with large-vessel involvement and support the use of extended scanning protocols. International guidelines vary in their emphasis on extended CDUS, but consensus is growing toward ultrasound imaging-first strategies in expert hands. Conclusion: Extended CDUS is a sensitive, non-invasive first-line diagnostic tool for GCA. In patients with symptoms of the posterior cerebral circulation and elevated inflammatory indices, early comprehensive vascular imaging reduces diagnostic delay and may obviate the need for temporal artery biopsy.

Journal of Vascular Diseases doi: 10.3390/jvd4030036

Authors: Gabrielle Gallagher Keith Handler Brian Ferguson

Background: Acute aortic occlusion (AAO) is a rare but life-threatening condition which can present with a spectrum of symptoms, ranging from mild cramping pain in the lower extremities (with or without sensory loss) to more dramatic motor loss and paraplegia. Once a diagnosis has been established, the treatment remains ambiguous, especially in a resource-limited setting. Treatment ranges from direct vascular intervention to systemic or directed thrombolysis—however, there is a lack of published literature on systemic thrombolysis, and thereby, consensus guidelines are nonexistent. Additionally, systemic thrombolysis bears a risk of hemorrhagic complications; however, the risk of death due to AAO is up to 57 times greater than the risk of intracerebral hemorrhage from systemic thrombolysis. Methods: This case report explores the prompt diagnosis of an acute aortic occlusion causing bilateral acute lower extremity ischemia in a sixty-three-year-old female patient treated with systemic thrombolysis. Results: The patient received 100 mg of tPA (without a bolus dose, over a two-hour period) in the Emergency Department (similar to that which is administered for the full-dose pulmonary embolism protocol). One hour after administration, the patient had restored flow to the bilateral lower extremities verified using bedside color-flow Doppler, with a drastic improvement in her symptoms. Two days after systemic thrombolysis, a repeat CTA showed evidence of complete resolution of her aortic clot. Her condition was complicated by a brief episode of retroperitoneal bleeding (presenting with flank pain) while on a heparin drip after admission (day two), which was resolved through discontinuation of the heparin drip and a two-unit blood transfusion. Conclusion: The patient was discharged with full function of the lower extremities on day six without anticoagulation. At her 2-week follow-up appointment, she was noted to be ambulatory without any neurodeficit, with a persistently restored arterial flow to the lower extremity. The application of systemic tPA could be paramount in the treatment of AAO in the setting of ischemic limb pathology, particularly at rural hospitals and healthcare centers where urgent direct vascular intervention may not be possible.

Journal of Vascular Diseases doi: 10.3390/jvd4030035

Authors: Carlo Coscarella Rocco Giudice Marta Minucci Adelaide Borlizzi Federico Francisco Pennetta Bernardo Orellana Davila Ciro Ferrer

Introduction: Isolated true subclavian artery aneurysm (SAA) is a rare form of peripheral arterial aneurysm that poses significant anatomical challenges to endovascular repair, especially in cases requiring planned vertebral artery (VA) sacrifice. The Balloon Occlusion Test (BOT) is a critical preoperative tool for evaluating collateral circulation before VA embolization. Case Report: A 74-year-old male was admitted with a pulsatile mass in the left supraclavicular fossa, and a 65 mm aneurysm of the intrathoracic segment of the left subclavian artery (LSA) involving critical arterial branches was diagnosed by computed tomography angiography. Due to his comorbidities, the patient was judged unfit for an open surgical repair of the aneurysm, and a two-stage endovascular subclavian aneurysm repair (EVSAR) was planned. The first step included embolization of the internal mammary artery and thyrocervical trunk, followed by BOT of the left VA, which confirmed an adequate perfusion of the posterior cerebral and cerebellar circulation that allowed safe VA embolization. The second step included zone 2 thoracic endograft placement (TEVAR) with LSA coverage and vascular plug occlusion of the proximal segment of the LSA and the axillary artery. Postoperative monitoring revealed no neurological deficit, and the patient was discharged home without complications. Follow-up imaging up to 24 months confirmed complete aneurysm exclusion and significant sac shrinkage. Conclusions: EVSAR with thoracic endograft and VA sacrifice, preceded by BOT, may be a safe and effective minimally invasive approach for the treatment of intrathoracic SAA.

Journal of Vascular Diseases doi: 10.3390/jvd4030034

Authors: Farhan Siddiq Sabrina Genovese Eisha Abid Ali Dahir Ashfaq Muhammad Shakir

Background/Objectives: Unruptured intracranial aneurysms (UIAs) carry a risk of subarachnoid hemorrhage (SAH), which has a high mortality rate of up to 45% and significant long-term disability among survivors. Traditional surgical clipping and endovascular treatment (EVT) are widely used, but both have limitations: EVT shows higher recurrence and retreatment rates, while open clipping poses higher procedural risks. Minimally invasive craniotomy (MIC) techniques are emerging as a promising third option, offering potential benefits in terms of safety, durability, and recovery. This study aims to compare MIC and EVT for UIAs to evaluate their relative efficacy, safety, and long-term outcomes. Methods: A systematic literature review was conducted using PubMed and Scopus. Inclusion criteria encompassed original, peer-reviewed studies reporting clinical outcomes of UIA treatments. Data extracted included study characteristics, treatment modality, complication rates, recurrence, retreatment, and patient outcomes. Results: MIC demonstrated low complication rates (1.6–5.88%), for which the percentage was significantly lower than that for stent-assisted coiling (37%) and flow diversion (17%), while maintaining similar efficacy to traditional clipping. New EVT techniques such as WEB devices showed less procedural risks (0.7%) but higher retreatment rates. Conclusions: This review shows that while traditional craniotomy for aneurysm clipping carries higher perioperative risk than EVT, most studies have failed to compare long-term recurrences. MIC has significantly lower perioperative complications rates, comparable to EVT, and provides the same durability with improved cosmetic results. MIC should be considered when selecting patients as an alternative to EVT, particularly for unruptured anterior circulation aneurysms. Further prospective studies are needed to guide treatment decisions.

Journal of Vascular Diseases doi: 10.3390/jvd4030033

Authors: David Doyle Samuel Kim Alexis Berry Morgan Belle Nicholas Panico Shawn Kaura Austin Price Taylor Reardon Margaret Ellen

Background/Objectives: Tick-borne diseases (TBDs) are increasingly recognized as causes of both systemic and neurologic illness. While their impact on vascular health is established, their role in cerebrovascular disease remains underexplored. This review aims to synthesize clinical evidence linking TBDs with cerebrovascular events, focusing on mechanisms of injury, pathogen-specific associations, and treatment outcomes. Methods: A narrative review was conducted using Boolean keyword searches across PubMed, Scopus, EMBASE, and Web of Science. Relevant literature on ischemic and hemorrhagic stroke, cerebral vasculitis, and stroke mimics associated with TBDs was examined. The review included case reports, observational studies, and mechanistic research. Pathogen-specific data and disease characteristics were extracted and summarized. Results: Several tick-borne pathogens were associated with cerebrovascular complications. Borrelia burgdorferi was most commonly implicated and typically presented with large-vessel vasculitis. Rickettsia, Ehrlichia, and Anaplasma species caused endothelial injury through immune-mediated inflammation. Powassan virus and Crimean–Congo hemorrhagic fever virus exhibited central nervous system involvement and hemorrhagic potential. Babesia species contributed to vascular injury through thrombocytopenia and embolic complications. Neuroimaging frequently demonstrated multifocal stenoses and vessel wall inflammation. Antimicrobial treatment, particularly with doxycycline or ceftriaxone, was often effective, especially when administered early. Supportive care for stroke symptoms varied by presentation and underlying pathogen. Conclusions: Cerebrovascular disease caused by tick-borne pathogens is an underrecognized but potentially reversible condition. Despite diverse etiologies, most pathogens share a final common pathway of endothelial dysfunction. Early recognition and targeted antimicrobial therapy, combined with supportive stroke care, are essential to improving patient outcomes.

Journal of Vascular Diseases doi: 10.3390/jvd4030032

Authors: Brianna Wheelock Miranda Grzywaczewski Marissa Flannery Deborah L. Feairheller

Background: Load carriage is an activity of daily living, can be an occupational risk, and is a popular method of resistance training. Type of carry could be related to vascular and blood pressure (BP) responses and may be related to cardiovascular risk. As physical activity is recommended by clinicians and exercise physiologists, understanding the vascular responses in relation to type of carry is important to consider in terms of risk. The purpose of this study was to compare the vascular health and BP responses to the farmer’s handle (load at the side of the body) and zercher (load in front of the body) carry and to examine sex differences in the responses. Methods: A total of 38 adults (22 females and 16 males) completed farmer’s handle and zercher load carriage with pre- and post-vascular measurements using pulse wave analysis. Results: We found that load carriage with weight in front of the body (zercher) elicits a larger increase in arterial stiffness (AIx@75), and load carriage with the load on the side of the body (farmer’s handle) elicits a larger increase in peripheral systolic BP. There were no sex differences in the responses to carry. Females exercise (3.1 vs. 4.8) and weight train (1.5 vs. 2.6) fewer times per week and had a lower resting systolic BP (121.5 ± 10.3 vs. 131.3 ± 8.3 mmHg) (p < 0.05). Both types of load carriage increased peripheral systolic BP, central systolic BP, and vascular stiffness (p < 0.05). Conclusions: Location of load carriage is important to consider based on potential cardiac risk of patients.

Journal of Vascular Diseases doi: 10.3390/jvd4030031

Authors: Alexander R. Neifert David Su Bauer E. Sumpio

Background: Premature atherosclerosis (PreAS) is generally defined as a disease affecting those under the age of 50 and has an outsized impact on quality-adjusted life years. We sought to better understand what individuals are at the highest risk for PreAS by examining differences in demographics and comorbidities compared to traditional atherosclerosis (TradAS). Study Design: An Institutional Review Board (IRB) approved retrospective study was conducted using retrospective data from a large regional health system. Patients who received a diagnosis of cerebrovascular disease (CeVD), coronary artery disease (CAD) or peripheral arterial disease (PAD) between 2012 and 2023 were included. Results: The review identified 136,328 patients in which 17,008 or 13% presented with PreAS (diagnosed from age 18 up to, and including, age 50). Rates of comorbidities were as follows (PreAs/TradAS): hypertension 63%/86%, diabetes 29%/35%. hyperlipidemia 45%/67%, chronic kidney disease 15%/26%, tobacco use 52%/60% and substance use 25%/9%. Differences in race, ethnicity and gender were as follows (PreAS/TradAS): White 59%/80%, Black 22%/10% and Latinx 17%/6%; male 51%/55%, and female 49%/45%. Conclusions: Patients with PreAS had lower rates of diseases that typically progress with aging, including hypertension, hyperlipidemia, chronic kidney disease, and diabetes. Tobacco use was less prevalent in the PreAS group and there was a significantly higher rate of illicit substance use in the PreAS population. Race and ethnicity were notably different with Black and Hispanic patients representing a significantly larger proportion of those with PreAS relative to TradAS. Our findings suggest risk factors beyond those classically described may play key roles in causing patients to develop PreAS.

Journal of Vascular Diseases doi: 10.3390/jvd4030030

Authors: Paolo Emilio Puddu Alessandro Menotti

The concepts of “isolated” or “idiopathic” heat failure (CHF/HF) and more recently of “non-dilated cardiomyopathy” lack a clear description of the specific characteristics that help condense the disease into a nomenclature-based list applicable to population studies. This ensued in the absence of primary preventive investigations of CHF/HF. Moreover, in the large spectrum of cardiovascular diseases (CVD), the conditions attributable to coronary heart diseases (CHD) from those related to CHF/HF or other causes are not in general disentangled. We review here current results prompting the operational idea to index heart diseases of uncertain etiology (HDUEs) from a population-based perspective in several contributions, where CHF/HF represented 50% of HDUEs, approximately 10% of all CVD mortality and approximately 5% of all-cause mortality. We wish to stimulate new studies that compare CHD with CHF/HF only, exploiting population data, excluding baseline prevalent heart diseases, including incidence cases and separately studies with large numbers of recruited individuals. These analyses may well be complemented by the use of the Fine-Gray variant of the Cox predictive model that, by the sub-distribution of hazard models, may enable identifying risk factors as the determinants of competition between groups of diseases. The aim is to better define the differences between CHD and CHF/HF along with the possible etiology and even specific risk factors of these independent CHF/HF cases. A surge of interest among the investigators should thus be stimulated. Eventually, also for this “character” (in Pirandello’s acception), an author may hopefully be found, thus complementing with etiology an apparently orphan condition.

Journal of Vascular Diseases doi: 10.3390/jvd4030029

Authors: Shahzad G. Raja

Coronary artery bypass grafting (CABG) has evolved into a cornerstone treatment for coronary artery disease, with graft selection playing a critical role in long-term outcomes. Multiple arterial grafting (MAG) represents a significant advancement over single arterial grafting, utilizing conduits such as the internal thoracic artery and radial artery to enhance graft durability and patient survival. This review examines the outcomes, challenges, and controversies associated with MAG, highlighting its superior patency rates and reduced need for repeat revascularization procedures. While the technique provides long-term survival benefits, concerns such as the complexity of surgical techniques, increased operative time, and higher resource utilization underscore the importance of surgeon expertise and institutional infrastructure. Patient selection remains critical, as factors like age, comorbidities, and gender influence outcomes and highlight disparities in access to MAG. Emerging evidence addresses debates regarding optimal graft choice and balancing long-term benefits against short-term risks. Future directions focus on ongoing clinical trials, innovations in minimally invasive and robotic-assisted CABG, and technological advancements aimed at improving graft patency. Professional guidelines and best practices underscore the need for personalized approaches to optimize MAG’s potential. This article underscores the promise of MAG in redefining CABG care, paving the way for enhanced patient outcomes and broadened applicability. This article highlights the promise of MAG in transforming CABG care, leading to improved patient outcomes and expanded applicability.

Journal of Vascular Diseases doi: 10.3390/jvd4030028

Authors: Ahmer Irfan Farah Ladak David Chan Carol-Anne Moulton Trevor Reichman Sean Cleary Gonzalo Sapisochin Chaya Shwaartz Ian McGilvray

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most common malignancies associated with thrombotic events. While there is research present on various techniques of portal vein reconstruction, there is limited published data on the techniques and/or considerations of reconstruction in the setting of complete portal vein occlusion. We therefore sought to analyze and present our experience of this clinical scenario. Methods: This was a retrospective analysis of a prospectively collected database. All patients who underwent portal vein resection and/or reconstruction during a pancreatic resection were included. Post-operatively, all patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for any portal vein thrombus. Results: Pancreatic resection with portal vein reconstruction was performed in 183 patients. Complete PV occlusion was seen in 12 patients at the time of surgery. In those patients with an occluded PV, reconstruction options included primary repair with end-end anastomosis (n = 2) or use of an interposition graft (n = 9). Interposition graft conduits included the left renal vein (n = 6), tubularized bovine pericardium (n = 3), and femoral vein (n = 1). Post-operative portal vein thrombus was seen in 4/12 patients. The majority of patients (n = 7) were discharged on therapeutic anticoagulation, 4 were discharged on an antiplatelet, and 1 patient received neither. Conclusions: Based on our series, we would recommend attempting PV reconstruction in these patients with an interposition graft (with autologous left renal vein or bovine pericardium). We believe that with this technique, the post-operative thrombosis risk is similar to PV reconstructions in non-occluded patients.

Journal of Vascular Diseases doi: 10.3390/jvd4030027

Authors: Ilaria Radano Fabrizio Delnevo Tiziana Claudia Aranzulla Salvatore Piazza Catia De Rosa Silvia Muccioli Maria Chiara Ferrua Trucco Andrea Ricotti Simone Quaglino Michelangelo Ferri Giuseppe Patti Andrea Gaggiano Giuseppe Musumeci

Background and aim: Low-density lipoprotein cholesterol (LDL-C) is an important and well-established modifiable risk factor for cardiovascular disease, including peripheral artery disease (PAD). We aimed at evaluating the lipid profile at admission in PAD patients with an indication for invasive treatment. Methods: Among patients with PAD diagnosis admitted to the vascular surgery department, those receiving statins and those with LDL-C values in the recommended target (<55 mg/dL) were identified. The correlation of LDL-C values with different clinical variables was investigated. Results: Of the 399 patients, 259 (65%) were on statin therapy. According to multivariate linear regression analysis, diabetes (p = 0.004), previous CAD history (p < 0.001), and statin therapy (p < 0.001) were independently associated with LDL-C levels. Patients with LDL-C < 55 mg/dL at admission were 89 (22% of the overall cohort). Among these patients, diabetes (48.3% versus 35.8%, p = 0.036), CAD history (52.8% versus 30%, p < 0.001), and statin use (91% versus 57.4%, p < 0.001) were more frequent as compared with patients not at target. Conclusion: Despite the very high cardiovascular risk of our group, the rate of statin prescription was very low and far from ideal. Only a small percentage of patients achieved target LDL-C values. Patients with coexistent diabetes and CAD had lower LDL-C values, suggesting management by specialists with greater attention to lipid profile and pointing out an urgent need for information on cardiovascular disease management.

Journal of Vascular Diseases doi: 10.3390/jvd4030026

Authors: İsa Ardahanlı Ramazan Aslan Halil İbrahim Özkan Faik Özel Murat Özmen

Aortic aneurysm is a vascular disease with a complex pathogenesis which is usually asymptomatic but can lead to high mortality with sudden rupture. This review comprehensively examines the molecular mechanisms of aortic aneurysms in the context of extracellular matrix destruction, smooth muscle cell apoptosis, chronic inflammation, oxidative stress, genetic mutations, and epigenetic regulations. In addition, the potential of molecular biomarkers in diagnosis and prognosis and targeted treatment strategies are evaluated. Animal models and translational findings form the basis for establishing a bridge between preclinical and clinical applications. This study aims to provide insight into the integration of molecular findings into clinical practice in light of the current literature and to guide future research.

Journal of Vascular Diseases doi: 10.3390/jvd4030025

Authors: Mauro Parozzi Antonio Bonacaro Mattia Bozzetti Giovanni Cangelosi Maria Bertuol Fabio Mozzarelli Paolo Ferrara Stefano Mancin Stefano Terzoni

Background/Objectives: Radial artery occlusion (RAO) following hemostasis after coronary procedures is the most common complication, with a highly variable incidence (1–33%). While it is well established that the patent hemostasis technique reduces RAO rates, it remains unclear which device should be preferred. The wide variety of available radial hemostasis devices makes it necessary to identify those associated with a lower incidence of complications. Methods: Literature from 2016 to 2021 was reviewed through a systematic search in PubMed, CINAHL, Cochrane, and Embase databases. Only randomized controlled trials (RCTs) involving adult patients undergoing percutaneous transradial coronary procedures were included. Devices considered included pneumatic compression devices, manual compression, elastic bandages, and hemostatic dressings. The review process followed PRISMA guidelines. Two random-effects frequentist network meta-analyses were conducted to compare the effects of 16 and 9 radial hemostasis devices on RAO incidence at 24 h and 30 days after the procedure. Results: A total of 17 RCTs were included. The network meta-analysis (NMA) showed a protective effect at the 24 h endpoint for both double-balloon devices and pneumatic compression devices adjusted to mean arterial pressure. At the 30-day endpoint, significant differences were observed among pneumatic compression, chitosan-based PADs, mechanical compression devices, and adjustable elastic bandages. Conclusions: Although some treatments with specific devices significantly differ from the reference treatment, the limited availability of data to assess RAO at 30 days and a certain heterogeneity between devices indicate the need for further investigation.

Journal of Vascular Diseases doi: 10.3390/jvd4030024

Authors: Rafic Ramses Obiekezie Agu

Late ruptures of abdominal aortic aneurysms post-endovascular aneurysm repair present a significant risk, occurring in about 0.9% of cases. The typical timeframe leading to rupture is roughly 37 months, with the primary factors often linked to endoleaks, especially types I and III, which sustain pressure within the aneurysm sac. The approaches to managing late ruptures consist of endovascular approaches, open surgical interventions, and conservative care, each customised to the patient’s specific characteristics. When feasible endovascular repair is favoured, additional stent grafts are deployed to seal endoleaks and offer lower perioperative mortality rates compared to those for open surgery. Open repair is considered when endovascular solutions fail or are not feasible. Conservative management with active monitoring and supportive treatment can be considered for haemodynamically stable non-surgical patients. Endovascular repair methods like fenestrated/branched EVAR (F/BEVAR) and parallel grafting (PGEVAR) are effective for complicated anatomies and show high technical success with reduced morbidity compared to that with open repairs. Chimney techniques and physician-modified endografts may help regain and broaden the sealing zone. Limb extensions with or without embolisation, interposition endografting, and whole-body relining are helpful options for type IB and type 3–5 endoleaks. Open surgical repair carries a higher perioperative mortality but may be essential in preventing death due to rupture following failed EVAR. The choice depends on the patient’s clinical stability and fitness for surgery in the absence of a viable endovascular alternative. This article discusses the available options for treating late rupture after EVAR, emphasising the importance of individualised treatment plans and the need for rigorous postoperative surveillance to prevent such complications.

Journal of Vascular Diseases doi: 10.3390/jvd4020023

Authors: Amar Premdatt Gopal Ankoor Patel Murad Elias Shreeya Agrawal Priya Goyal David Samson Igor Laskowski Romeo Mateo Arun Goyal Sateesh Babu

Patients with End-Stage Renal Disease (ESRD) represent a very fragile population, presenting with higher rates of complications and morbidity following vascular interventions. This study aims to analyze post-operative outcomes, such as mortality, readmissions, and amputations, in patients with Peripheral Arterial Disease (PAD) and ESRD on dialysis. Methods: A retrospective cohort study was conducted of patients with PAD and ESRD on dialysis who underwent vascular interventions between 2015 and 2017. This study focused on post-operative outcomes, including mortality, readmissions, and amputations. The data were analyzed to identify patterns and correlations. Results: This study found that patients with PAD and ESRD have long hospital stays, high amputation rates, high readmission rates, and treatment failure. Above-knee amputation (AKA) and female gender were associated with higher mortality rates, while prior stroke was associated with higher odds of readmissions. Conclusions: This study highlights the need for further studies with larger patient populations to identify independent predictors of negative outcomes. The findings suggest that specific factors, such as AKA, female gender, and prior stroke, significantly impact post-operative outcomes in this patient population.

Journal of Vascular Diseases doi: 10.3390/jvd4020022

Authors: Bianca de Souza Soares Maria Clara Gomes Alves Carlos Eduardo Cantelmo Bruna Cristina de Oliveira Barros Gustavo Vieira de Oliveira

Objectives: This study investigates the effects of cluster set resistance training (RT) on heart rate variability (HRV) parameters in young, healthy individuals. Methods: This trial was registered in the Brazilian Clinical Trials Registry (ReBEC) under the identification number RBR-9857xj3 on 7 December 2024. Sixteen participants (seven female, 25 ± 2 years old) performed both cluster set and traditional RT protocols with equal relative intensity (85% 10RM), volume load (4 × 10 repetitions), and rest intervals (120 s). Cluster set configuration involved the introduction of a shorter rest interval between a cluster of sets [4 × (2 × 5) with 90 s inter-set rest and 30 s intra-set rest]. HRV parameters (RMSSD, HFnu, SD1, LFnu, LF/HF ratio, and SD2) were assessed before and 30 min post-exercise. The rating of perceived exertion (RPE) was assessed immediately after RT protocols. Results: The traditional RT protocol led to a significant reduction in parasympathetic activity (RMSSD, HFnu, SD1) and an increase in sympathetic activity (LFnu, LF/HF ratio, and SD2) (p < 0.05), whereas the cluster set RT protocol did not alter HRV parameters. Additionally, RPE was significantly higher (p < 0.001) in the traditional RT protocol. Conclusion: This study suggests that the cluster set may have a less pronounced impact on HRV parameters 30 min post-exercise compared to traditional sets. These findings can guide exercise physiologists in designing resistance training programs for clinical populations by prescribing protocols that minimize cardiac autonomic stress.

Journal of Vascular Diseases doi: 10.3390/jvd4020021

Authors: Melvin R. Hayden

Peripheral artery disease (PAD) is a chronic progressive accumulation of atherosclerotic lesions with varying degrees of arterial obstruction determining ischemic symptoms of the involved extremities. PAD is associated with decreased bioavailable nitric oxide due to endothelial cell dysfunction and the development and progression of vascular arterial stiffening (VAS). Atherosclerosis also plays an essential role in the development and progression of vascular arterial stiffening (VAS), which is associated with endothelial cell activation and dysfunction that results in a proinflammatory endothelium with a decreased ability to produce bioavailable nitric oxide (NO). NO is one of three gasotransmitters, along with carbon monoxide and hydrogen sulfide, that promotes vasodilation. NO plays a crucial role in the regulation of PAD, and a deficiency in its bioavailability is strongly linked to the development of atherosclerosis, VAS, and PAD. A decreased arterial patency may also occur due to a reduction in the elasticity or diameter of the vessel wall due to the progressive nature of VAS and atherosclerosis in PAD. Progressive atherosclerosis and VAS promote narrowing over time, which leads to impairment of vasorelaxation and extremity blood flow. This narrative review examines how atherosclerosis, aging and hypertension, metabolic syndrome and type 2 diabetes, tobacco smoking, and endothelial cell activation and dysfunction with decreased NO and VAS with its increased damaging pulsatile pulse pressure result in microvessel remodeling. Further, the role of ischemia and ischemia–reperfusion injury is discussed and how it contributes to ischemic skeletal muscle remodeling, ischemic neuropathy, and pain perception in PAD.

Journal of Vascular Diseases doi: 10.3390/jvd4020020

Authors: Beatriz Macacari Beatriz Roberta da Silva Maria Eduarda Ferreira Pereira Lívia Maria de Jesus Pereira Ana Beatriz Perez Bertochi Gabriela Torres Pinheiro Marcela Arietti Ana Quevedo Nailza Maestá Cláudio Lera Orsatti

Background: Stroke is a major cause of morbidity and mortality worldwide, with distinct pathophysiological mechanisms between ischemic stroke (IS) and hemorrhagic stroke (HS). Hematological parameters, such as lymphocyte and erythrocyte count, have been implicated in stroke prognosis, but their predictive value remains uncertain. Objective: To evaluate the association between hematological biomarkers and stroke subtypes (ischemic stroke and hemorrhagic stroke), and transient ischemic attack. Methods: This cross-sectional study analyzed clinical, metabolic, and hematological parameters in patients with stroke. Logistic regression models, adjusted for age, gender, and ethnicity, were applied to assess the association between lymphocyte and erythrocyte counts and stroke subtypes. Results: Lymphopenia was significantly associated with higher odds of hemorrhagic stroke (HS) in both the TIA–HS (OR 1.15, 95% CI: 1.05–1.26, p = 0.004) and the IS–HS models (OR 1.11, 95% CI: 1.03–1.20, p = 0.009). Additionally, erythrocyte count was significantly associated with increased odds of conversion from IS to HS (OR 3.97, 95% CI: 1.45–10.89, p = 0.007). The lymphocyte-to-monocyte ratio (LMR) was significantly different between IS and HS (OR = 1.38, 95% CI: 1.07–1.78, p = 0.014), while no significant association was found between TIA and HS (p = 0.399). Conclusions: Hematological parameters varied among stroke subtypes, with lymphopenia associated with hemorrhagic stroke and erythrocyte count differing between IS and HS. While these findings may aid in stroke characterization, further studies are needed to confirm their clinical relevance.

Journal of Vascular Diseases doi: 10.3390/jvd4020019

Authors: Lakshmi Sree Pugalenthi Chris Garapati Srivarshini Maddukuri Fnu Kanwal Jaspreet Kumar Naghmeh Asadimanesh Surbhi Dadwal Vibhor Ahluwalia Sidhartha Gautam Senapati Shivaram P. Arunachalam

Background: Varicose veins (VVs) of the lower limbs, characterized by palpable, dilated, and tortuous veins, affect 2–73% of the global population. Artificial intelligence (AI) offers significant potential to enhance healthcare efficiency and decision-making, particularly in managing VVs through improved risk factor identification, diagnosis, and treatment planning. Objective: This abstract explores the role of AI in VV management, focusing on its applications in risk detection, image analysis, treatment planning, and surgical interventions, while addressing challenges to its widespread adoption. Methods: AI leverages advanced techniques such as computer vision and deep learning to analyze patient data, including medical history, symptoms, physical examinations, and imaging (e.g., ultrasounds, venography). It identifies patterns in large datasets to support personalized treatment plans, early risk detection, and disease severity assessment. Results: AI demonstrates promise in automating VV detection and classification, assessing disease severity, and aiding treatment planning. It enhances surgical interventions through preoperative planning, intraoperative navigation, and recurrence risk prediction. However, its adoption is limited by a lack of large-scale studies, concerns over accuracy, and the need for regulatory and ethical oversight. Conclusion: AI has the potential to revolutionize VV management by improving diagnosis, treatment precision, and patient outcomes. Further research, validation, and integration are critical to overcoming current limitations and fully realizing AI’s capabilities in clinical practice.

Journal of Vascular Diseases doi: 10.3390/jvd4020018

Authors: Kunaal S. Sarnaik Saeid Mirzai

The aging of the global population over recent decades has resulted in an increased prevalence of hypertension in older adults. Hypertension develops with increasing age primarily due to a disastrous feedback loop of increased arterial stiffness and maladaptive hemodynamics; this is compounded by age-related changes in physiology. The risk of adverse hypertension-related outcomes concurrently increases with age, and optimal blood pressure (BP) control in older adults thus becomes increasingly important each year. The results of several randomized clinical trials (RCTs) evaluating antihypertension strategies in older adults have concluded that the potential benefits of intensive BP management outweigh the risks of harm. However, the exclusion of frail, multimorbid, and institutionalized individuals limits the generalizability of such findings to the broader population of older patients with hypertension. Secondary analyses and external studies have continued to support intensive BP control strategies in older adults with frailty or sarcopenia. Therefore, based on available evidence, clinicians should continue practicing intensive BP control strategies in the older population, yet careful consideration of functional status, life expectancy, medication side effects, polypharmacy, and multimorbidity must take place to avoid unnecessary harm. Strategies must then be tailored to accommodate modifiers such as frailty and sarcopenia in older adults with hypertension. Knowledge gaps underscore the need for future studies evaluating BP management in older adults that incorporate greater proportions of multimorbid and institutionalized individuals with frailty, assess personalization of treatment, and identify subgroups in which optimal BP levels exist or the permissibility of higher BP levels is safer than BP reduction.

Journal of Vascular Diseases doi: 10.3390/jvd4020017

Authors: Carolina Percul Veronica Busoni Carina Izquierdo Pablo A. Lobos

Background: Vascular Ehlers–Danlos syndrome (vEDS) is a rare connective tissue disorder characterized by collagen type III deficiency, predisposing to spontaneous arterial, uterine, and intestinal ruptures. While intestinal complications are recognized in vEDS, intestinal failure (IF) secondary to these complications is a rare and potentially life-threatening occurrence. This study aimed to describe the clinical presentation, surgical management, and outcomes of pediatric patients with IF secondary to vEDS and to provide a comprehensive review of the limited existing literature on this challenging clinical scenario. Methods: This study comprises a case series of pediatric patients with IF due to vEDS complications and a comprehensive literature review. Clinical data were collected from medical records, including age at diagnosis, surgical history, complications, nutritional status, and long-term outcomes. A literature review was performed to identify studies reporting gastrointestinal complications, surgical outcomes in pediatric vEDS patients, and cases of intestinal failure. Results: Two pediatric patients with vEDS and IF were included. Both patients experienced intestinal perforations and surgical complications and required long-term parenteral nutrition (PN). One patient required PN for 18 months before achieving enteral autonomy, while the other remains dependent. The literature review included four articles and revealed a high risk of complications, including anastomotic leaks, fistulae, and recurrent perforations, in patients with vEDS undergoing intestinal surgery. Delayed diagnosis of vEDS was common. Conclusions: Intestinal complications in pediatric patients with vEDS can lead to severe short bowel syndrome and long-term PN dependence. Early diagnosis and a multidisciplinary approach are crucial for optimizing patient care and minimizing complications.

Journal of Vascular Diseases doi: 10.3390/jvd4020016

Authors: Tommaso Casseri Maria Giulia Maccaglia Ivano Lombardo Andrea Bianchi Rosaria Tartarone Giorgio Busto Andrea Ginestroni Sara Speziali Walter Dorigo Enrico Fainardi

Cerebral microbleeds (CMBs) are increasingly detected in patients with aortic and cardiac diseases following transcatheter aortic valve implantation (TAVI), thoracic endovascular aortic repair (TEVAR), or cardiac surgery. CMBs can be observed in magnetic resonance imaging (MRI) when susceptibility-weighted imaging (SWI) or T2*-Gradient-Echo (GRE) sequences are used. Differential diagnosis of CMBs from other causes, such as cerebral amyloid angiopathy (CAA), is crucial because of its clinical implications, particularly for anticoagulation management. A literature search was conducted using publicly available online databases to identify relevant studies for this review. The selection criteria focused on publications utilizing MRI with T2*-GRE or SWI sequences to detect CMBs in patients following cardiac or endovascular procedures. The extracted data included study characteristics, lesion distribution, and associated clinical factors. Ten studies were included in this review, with 50% analyzing a prospective cohort. Cerebral T2*-GRE or SWI hypointensities after cardiac and vascular procedures often showed a lobar distribution, thus complicating the differential diagnosis with “probable” CAA. However, CMBs seem predominantly located in subcortical white matter (SWM), unlike CAA, and commonly not associated with other alterations. Furthermore, CMBs seem to correlate with prolonged procedural duration, especially in the case of cardiopulmonary bypass, and anticoagulation therapy. Regarding etiology, various hypotheses have been proposed, with the most widely accepted being microhemorrhagic. CMBs are a common finding following cardiac procedures, either surgical or endovascular. Their distribution patterns may aid in differentiating from CAA-related lesions, with important implications for anticoagulation strategies. Identifying and characterizing these lesions is essential for optimizing postoperative management.

Journal of Vascular Diseases doi: 10.3390/jvd4020015

Authors: Kaio F. Secchinato Pedro H. R. da Silva Guilherme R. Rodrigues Ana P. A. C. Ferreira Octavio M. Pontes-Neto Renata F. Leoni

Background/Objectives: Cerebrovascular reactivity (CVR) and time shift (TS) are vascular-related parameters that reflect cerebral perfusion and may be associated with the risk of developing stroke in patients with asymptomatic carotid artery stenosis (ACAS). We investigated CVR and TS in patients with ACAS using resting-state magnetic resonance imaging based on blood-oxygen-level-dependent contrast (BOLD-MRI). Methods: We included twenty patients with severe unilateral ACAS and twenty age-matched controls. Individual CVR maps were obtained through a voxel-wise regression of the MRI signal, using the global signal filtered in a specific frequency range (0.02–0.04 Hz) as the regressor. A recursive cross-correlation method provided individual TS maps through the BOLD low-frequency fluctuation. CVR and TS values were obtained for the territories irrigated by the main cerebral arteries (anterior, middle, and posterior) separated into proximal, intermediary, and distal regions. Results: Compared to controls, ACAS patients presented reduced CVR and increased TS in the distal parts of the brain vascular territories. Individual CVR and TS values varied more within the patient group than controls. Such individual variability may help identify patients eligible for intervention better than the stenosis grade. Conclusions: CVR and TS may indicate subtle hemodynamic changes and assist in identifying regions at higher risk of neuronal damage or ischemic stroke on an individual basis, aiding in the stratification of patients with ACAS based on their risk of progressing to stroke.

Journal of Vascular Diseases doi: 10.3390/jvd4020014

Authors: Niccolò Fagni Luca Valli Giulio Nittari Giulio Procelli Jacopo Junio Valerio Branca Roberto Cuomo Marco Mandalà Eugenio Bertelli Sebastian Cotofana Ferdinando Paternostro

Background: The superficial temporal artery (STA) typically bifurcates into frontal and parietal branches in the temporal region. This study describes a rare anatomical variation identified during a cadaveric dissection where the STA presented an early cervical bifurcation. Methods: A cadaveric dissection was performed on a 58-year-old Caucasian female specimen injected with synthetic polymers. The STA was meticulously dissected, and anatomical findings were documented through photographs and measurements. Results: An unusual cervical bifurcation of the STA was observed. The frontal and parietal branches originated at the level of the posterior belly of the digastric muscle, ascending separately. The anterior branch, identified as the frontal branch, coursed below the facial nerve and stylomastoid artery, reaching the temporal line without further branching after giving the transverse facial artery as the only collateral branch. The posterior parietal branch extended posteriorly to the external acoustic meatus, compensating for the absence of the posterior auricular artery. This anatomical variation might influence surgical approaches to the head and neck region, particularly in parotid and reconstructive surgeries. Discussion: Variations in STA anatomy can significantly impact clinical practices, including reconstructive surgery, vascular interventions, and esthetic procedures. Imaging techniques, though useful, may not detect such rare variants. Cadaveric dissection remains a crucial tool for detailed anatomical assessment. Conclusions: This study highlights the importance of recognizing the STA’s vascular variations for safe surgical planning and improving patient outcomes. Further studies correlating imaging findings with cadaveric dissections are recommended.

Journal of Vascular Diseases doi: 10.3390/jvd4020013

Authors: Jinmo Kang Daisik Ko Juhun Lee

Background: Endovascular aortic aneurysm repair (EVAR) is a commonly used treatment for abdominal aortic aneurysms (AAAs), but anatomical complexities limit its application in certain cases. Objective: This study evaluates the mid-term outcomes, referring to a follow-up period with a mean of 29.9 ± 24.1 months (approximately 1–5 years), of a novel double-barrel technique that employs overlapping tubular stent grafts to address these challenges. Methods: A retrospective analysis was conducted on seven patients treated with this technique from May 2014 to February 2023. Patients had narrow and short proximal necks, inadequate landing zones, or required re-do procedures. Results: The double-barrel technique achieved technical success in 85.7% of cases with zero mortality. Patients had an average hospital stay of 11.9 ± 10.0 days and attended follow-up for a mean of 29.9 ± 24.1 months. Minimal complications and no significant adverse events were reported. Conclusions: These findings suggest that the double-barrel technique is a cost-effective and viable alternative for anatomically complex cases where standard EVAR is unsuitable. While promising mid-term outcomes were observed, further studies with larger cohorts are necessary to confirm its long-term effectiveness and broader applicability.

Journal of Vascular Diseases doi: 10.3390/jvd4020012

Authors: Lifei Zhu Milan Regmi Syed S. Fatmi

Background: Mycotic aneurysms of the subclavian artery are infrequent and pose significant diagnostic challenges, particularly in the context of recurrent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The concomitant presence of upper extremity deep vein thrombosis (UEDVT) further complicates the management of bleeding risk and the necessity for anticoagulation therapy. Methods: This report discusses a 75-year-old male patient with a medical history of lung and skin cancer undergoing immunotherapy who presented with a swollen and painful right arm. Ultrasound examination identified deep vein thrombosis in the right axillary and basilic veins, and blood cultures confirmed MRSA infection. Subsequent imaging revealed bilateral subclavian artery aneurysms with contained ruptures involving previously placed stent grafts. Emergent endovascular interventions were performed to prevent catastrophic hemorrhage. Results: Despite the initial interventions, concerns regarding infected stent grafts persisted due to ongoing MRSA bacteremia and the presence of an endoleak. The complexity of balancing anticoagulation for DVT with the risk of aneurysm rupture necessitated the patient’s transfer to a tertiary care center for potential open surgical debridement. Conclusions: This case underscores the diagnostic and therapeutic challenges associated with the simultaneous occurrence of vascular infection, thrombosis, and aneurysmal pathology. Although emergency endovascular repair provided temporary hemostatic control, definitive management may require graft removal if stent infection is confirmed. Optimal care in such complex clinical scenarios demands a multidisciplinary approach and may necessitate advanced surgical interventions.

Journal of Vascular Diseases doi: 10.3390/jvd4010011

Authors: Patryk Skórka Jacek Szulc Konrad Szewczyk Adam Szafirowski Piotr Gutowski Maciej Wojtuń Paweł Rynio

Median Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric tenderness. The condition most commonly affects young females without coexisting vascular comorbidities. Diagnosis is difficult due to the non-specific symptoms, often overlapping with other gastrointestinal diseases. Standard investigations include duplex ultrasound, computed tomography angiography (CTA) and contrast-enhanced magnetic resonance imaging (CE-MRA). Treatment mainly consists of surgical release of the arch ligament, which can be performed by open, laparoscopic or robotic methods. Surgery is often supported by celiac truncal stenting for residual stenosis, which significantly improves vascular flow. Alternative approaches include visceral plexus blocks and novel hybrid techniques, such as a combination of ligament release and endovascular treatment of the celiac trunk. In severe cases, vascular by-passes are recommended. The aim of this paper is to discuss the clinical manifestations, diagnostic possibilities, therapeutic options and directions for further research on MALS from the perspective of a vascular surgeon. It emphasizes the need for a multidisciplinary approach, including collaboration between the surgeon, radiologist, gastroenterologist and psychologist, which enables comprehensive disease management and improved quality of life for patients. In addition, the need for further development of diagnostic and therapeutic methods for early diagnosis and effective treatment was pointed out.

Journal of Vascular Diseases doi: 10.3390/jvd4010010

Authors: José Silva Juan Tonheiro Fernanda Rodrigues

Renal artery stenosis (RAS) is a vascular condition characterized by narrowing of one or both renal arteries, leading to reduced blood flow to the kidneys, activation of the renin–angiotensin–aldosterone system (RAAS), and subsequent renovascular hypertension. Overactivation of the same cascade potentiates the production of angiotensin II, which induces systemic vasoconstriction, increases sodium and water retention via aldosterone, and activates the sympathetic nervous system. Angiotensin II is also implicated in endothelial dysfunction, oxidative stress, and chronic inflammation, thus impairing vascular remodeling and arterial stiffness, all of which serve to accelerate cardiovascular complications, such as left ventricular hypertrophy, heart failure, and myocardial infarction. RAS is usually due in at least 90% of cases to atherosclerosis, which typically affects older people with diabetes and smoking as risk factors. There are two types of RAS: unilateral and bilateral. Bilateral RAS is commonly associated with flash pulmonary edema, a life-threatening emergency condition in which alveolar space flooding can occur within minutes. RAS typically remains asymptomatic until the late stage with complications of hypertension, ischemic nephropathy, or chronic kidney disease. FMD tends to create structural abnormalities of the artery, whereas atherosclerosis causes plaque formation and endothelial dysfunction of the artery. Epidemiological surveys have revealed that the prevalence of RAS ranges from 4% to 53% and is especially high among patients with hypertension, cardiovascular disease, or CKD. Diagnosis is based on clinical suspicion and supported by imaging studies, including Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography. Early detection also relies on certain laboratory biomarkers, especially in identifying high-risk patients. These markers would include increased plasma renin activity, elevated aldosterone-renin ratio, and inflammatory markers, including C-reactive protein and endothelin-1. Treatment would also involve pharmacological approaches, including RAAS inhibitors, beta-blockers, and statins, and interventional treatments, including angioplasty and stenting in patients with severe forms of the disease. However, the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) Trial showed that most patients would likely require medical therapy, and that intervention should be reserved for those with uncontrolled hypertension, progressive renal dysfunction, or recurrent episodes of pulmonary edema. Other emerging therapies include drug-eluting balloons, bioresorbable stents, and gene-editing techniques, all of which have shown great promise in the few studies that have been conducted, although further evaluation is needed. Despite these advances, there are still gaps in knowledge regarding patient stratification, biomarker validation, and the development of personalized treatment strategies. This article reviews the complexities of RAAS and its systemic impact on cardiovascular and renal health. Future research can therefore focus on improving early diagnosis, optimizing patient selection for intervention, and developing new therapies to slow disease progression and mitigate complications.

Journal of Vascular Diseases doi: 10.3390/jvd4010009

Authors: Pedro Rafael Vieira de Oliveira Salerno Alena Gonzalez Avery Hum Ariela Baur Colin Carpenter Mohamed Bassiony Vaibhav Shah Zhuo Chen Weichuan Dong Sadeer Al-Kindi

Cardio-Kidney-Metabolic (CKM) Syndrome is a complex systemic disorder characterized by interactions between metabolic risk factors such as obesity, Type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and cardiovascular disease (CVD). These interactions contribute to multi-organ dysfunction and a heightened risk of cardiovascular complications. The American Heart Association (AHA) emphasizes the importance of a comprehensive approach to CKM management, incorporating social and environmental determinants of health (SEDH) to better understand disease progression and outcomes. Among these determinants, neighborhood walkability—the extent to which an area supports walking and physical activity—has emerged as a critical yet understudied factor influencing CKM health. This scoping review aims to synthesize the existing evidence on the relationship between neighborhood walkability and CKM outcomes, examining potential pathways, health disparities, and opportunities for targeted interventions.

Journal of Vascular Diseases doi: 10.3390/jvd4010008

Authors: Olga Belousova Denis Semenov Eugenia Boulygina Svetlana Tsygankova Alexander Konovalov

Background: Cerebral cavernous malformations (CCMs) are vascular lesions linked to mutations in the CCM1, CCM2, and CCM3 genes, resulting in angiogenesis dysregulation. This case study highlights the clinical course of a child with severe CCMs and explores the genetic basis of the condition. Methods: We used comprehensive clinical assessment and magnetic resonance imaging (MRI) to monitor the patient’s neurological status and CCM progression and genetic analysis by whole-exome sequencing to identify mutations in CCM-related genes. Results: The patient presented with developmental delays, multiple CCMs, and recurrent hemorrhagic events, requiring five surgical interventions. Genetic analysis revealed a novel frameshift mutation in the PDCD10 gene. Despite surgical efforts, the patient developed significant disability by age 13. Conclusions: This case illustrates the aggressive clinical course associated with CCMs, particularly in patients with CCM3 mutations. It underscores the importance of genetic screening and monitoring in understanding hereditary CCM progression and guiding treatment strategies.

Journal of Vascular Diseases doi: 10.3390/jvd4010007

Authors: Sofija Tusheva Gordana Georgieva Blagoja Srbov Savetka Paljoskovska Jordanova Katerina Jovanovska Stefania Azmanova Mladenovska Muamet Memeti Darko Aleksovski Biljana Mileska Krzhaloska Sofija Pejkova

Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is revolutionizing surgery by providing a bloodless field without tourniquet use, reducing risks, costs, and enhancing patient comfort. While extensively used in hand surgery, its application in foot and ankle procedures, particularly for high-risk patients with diabetic neuropathy and peripheral artery disease (PAD), remains underexplored. This study evaluates the safety, efficacy, and outcomes of WALANT for tarsal tunnel decompression in such patients. Methods: Between March 2022 and April 2024, 32 patients with diabetic neuropathy and PAD underwent Dellon decompression of the tarsal tunnel. Five received spinal anesthesia with a tourniquet, while 27 underwent WALANT. Outcomes assessed included operative time, Visual Analogue Scale (VAS) pain scores, posterior tibial artery blood flow (via Doppler ultrasonography), and complications. Data were collected preoperatively, immediately postoperatively, and at six and nine months. Results: WALANT reduced operative time (40 ± 8 min vs. 65 ± 10 min) and required fewer personnel (four vs. six). VAS scores improved significantly in the WALANT group (from 8.65 ± 0.84 preoperatively to 1.21 ± 0.24 at nine months). Posterior tibial artery blood flow also showed superior improvements with WALANT (5.30 ± 0.65 cm3/s vs. 2.50 ± 0.45 cm3/s). Minor wound healing delays were noted in two WALANT cases; no major complications occurred. Conclusion: WALANT offers a safe, efficient alternative to spinal anesthesia for tarsal tunnel decompression in high-risk patients, minimizing ischemic risks, enhancing vascular outcomes, and reducing postoperative pain.

Journal of Vascular Diseases doi: 10.3390/jvd4010006

Authors: Sydney Garner Yaman Alsabbagh Mariano Sorrentino Rockey Dahiya Jonathan Vandenberg Biraaj Mahajan Young Erben Houssam Farres Erik Anderson Brian Fazzone Amanda Filiberto Christopher Jacobs

We present an 81-year-old male with an extensive past medical history and an enlarging abdominal aortic aneurysm (AAA). Axial imaging showed dense aortoiliac calcification with a complete occlusion of the right common iliac and high-grade stenosis of the left common iliac artery (CIA). Shockwave Intravascular Lithotripsy and the pave-and-crack technique utilizing an endoconduit were used to dilate the left external iliac artery and the CIA to facilitate placement of an aortic stent graft and exclude the patient’s AAA. This method gives surgeons the ability to treat patients with AAAs endovascularly, despite a heavily diseased and/or diminutive iliac anatomy. We also present a contemporary literature review of the utilization of the pave-and-crack technique as well as tips and tricks of how we do it.

Journal of Vascular Diseases doi: 10.3390/jvd4010005

Authors: Zain Husain Islam Hongzhang Mei Zoe Tetz Rohan Kanchetty Sophia Stanisic Nicholas Hoyt William Aaron Marcum Campbell Johnston Eric William Kent Mengxue Zhang Nina Islam Alvin Anand Kaijie Zhang Li Yin Bowen Wang

Abdominal aortic aneurysm (AAA) is a prevalent vascular disease with high mortality rates upon rupture. AAA features a distinct sexual dimorphism, with a prevalence three times higher in males than in females. Interestingly, females are faced with a greater risk of rupture and a worse prognosis following surgical repairs. Nevertheless, stratified approaches for managing and predicting outcomes of AAA in male and female patients remain limited, largely hindered by our incomplete understanding of the mechanisms underlying this sex dimorphism. In this article, we will summarize the recent clinical and preclinical efforts aimed at understanding the therapeutic and mechanistic implications of sex-specific factors shaping AAA.

Journal of Vascular Diseases doi: 10.3390/jvd4010004

Authors: Ana S. Salazar Louis Vincent Bertrand Ebner Nicholas Fonseca Nogueira Leah Krauss Madison S. Meyer Jelani Grant Natalie Aguilar Mollie S. Pester Meela Parker Alex Gonzalez Armando Mendez Adam Carrico Barry E. Hurwitz Maria L. Alcaide Claudia Martinez

Background: People with HIV (PWH) are at increased risk of vascular dysfunction and cardiovascular disease (CVD). SARS-CoV-2 infection has been associated with acute CVD complications. The aim of the study was to as-sess macrovascular function as an early indicator of CVD risk in PWH after mild SARS-CoV-2 infection. Methods: PWH aged 20–60 years, with undetectable viral load (RNA < 20 copies/mL), on stable anti-retroviral therapy (≥6 months) and history of mild COVID-19 (≥30 days) without any CVD manifestations prior to enrollment were recruited. Participants were excluded if they had history of diabetes mellitus, end-stage renal disease, heart or respiratory disease. Participants were matched 1:1 to pre-pandemic PWH. A health survey, surrogate measures of CVD risk, and macrovascular function (brachial artery flow-mediated vasodilation and arterial stiffness assessments via applanation tonometry) were compared between group. Results: A total of 17 PWH and history of COVID-19 (PWH/COV+) were matched with 17 PWH without COVID-19 (PWH/COV−) pre-pandemic. Mean age (45.5 years), sex (76.5% male), body mass index (27.3), and duration of HIV infection (12.2 years) were not different between groups. Both groups had comparable CVD risk factors (total cholesterol, LDL, HDL, systolic and diastolic blood pressure). There were no differences in measures of flow mediated arterial dilatation or arterial stiffness after 30 days of SARS-CoV-2 infection. Conclusions: After recent SARS-CoV-2 infection, PWH did not demonstrate evidence of macrovascular dysfunction and increased CVD risk. Results suggest that CVD risk may not be increased in people with well-controlled HIV who did not manifest CVD complications SARS-CoV-2 infection.

Journal of Vascular Diseases doi: 10.3390/jvd4010003

Authors: Benito Baldauf Roberto Cemin Jana Hummel Hendrik Bonnemeier Ojan Assadian

Background: Central venous access devices (CVADs) are crucial for various medical conditions, but pose risks, including catheter-related bloodstream infections (CRBSI). CRBSI increases comorbidity, mortality, and healthcare costs. Surveillance and evidence-based guidelines have successfully reduced CRBSI rates, although the COVID-19 pandemic has led to increased infection rates. Main body: This review explores strategies for reducing the incidence of CRBSI and examines factors contributing to variations in reported rates across developed countries. Highlighting the significant morbidity, mortality, and healthcare resource burden associated with CRBSI, the analysis delves into evidence-backed preventive measures. It discusses the impact of the COVID-19 pandemic on infection rates and proposes resilient strategies in response to these challenges. The review emphasises the importance of understanding CRBSI pathogenesis, patient, procedure, and device-related risk factors, and the implementation of evidence-guided algorithms and surveillance measures. Recommendations include the use of all-inclusive procedure packs, ultrasound-guided placement, daily dressing changes with antimicrobial treatment, and the use of antimicrobial locks. Conclusions: The review underscores the need for clear, concise algorithms adaptable to various healthcare settings and the scalability of infection prevention systems to ensure resilience.

Journal of Vascular Diseases doi: 10.3390/jvd4010002

Authors: Jen-Kuang Lee Mu-Yang Hsieh Hung-Chi Su Po-Chao Hsu Chung-Ho Hsu Hsin-Fu Lee

Endovascular revascularization is a critical strategy in managing total occlusions of the femoropopliteal artery, a significant challenge in patients with peripheral artery disease (PAD). This review provides a comprehensive analysis of procedural strategies, highlighting the role of drug-coated balloons, atherectomy devices, and advanced crossing techniques like subintimal recanalization and re-entry methods. It discusses the importance of lesion-specific considerations, such as the use of atherectomy devices for un-crossable or un-dilatable lesions and the effectiveness of drug-coated balloons in reducing restenosis. Emerging techniques, including the PIERCE needle-cracking method and intravascular lithotripsy, offer novel approaches for treating heavily calcified plaques. Moreover, the review compares endovascular interventions with surgical bypass, noting that while minimally invasive techniques are preferred for high-risk patients, a hybrid approach may be optimal for selected cases. Despite advances, challenges remain regarding long-term outcomes and the management of complex calcified lesions, emphasizing the need for ongoing research and innovation in this field.

Journal of Vascular Diseases doi: 10.3390/jvd4010001

Authors: Chia-Ding Shih Tiffany Lee Sarah Hassan Hoanganh Chau Brandon M. Brooks Benjamin Zhang Emily R. Rosario

Background: The influence of health literacy on PAD outcomes remains poorly understood, particularly in minoritized communities. The objective of this study is to examine the understanding of PAD within San Francisco’s Chinese-speaking population while discerning preferences regarding learning methods. Materials and Methods: An anonymous 14-question survey in Mandarin and English was conducted in two San Francisco Chinatown health fairs. Results: About one-third of the respondents (29/91) reported prior knowledge about PAD and that arthritis was the leading symptom related to PAD (32/65). Half of respondents (44/88) preferred consulting a family doctor for foot wounds, followed by a podiatrist (27/88) and a general surgeon (19/88). The top three methods to receive health information were radio, television and newspaper. Those who were 65 years old and above (OR 0.124, 95% CI [0.021–0.0728]) and participants who were proficient in English (OR 0.078; 95% CI [0.012–0.52]) less preferred using radio to receive health information. Male gender preferred newspapers to receive health information (p = 0.003, OR 5.26; 95% CI [1.76–15.69]). Discussion: Our findings may suggest a community-specific campaign to increase the awareness of PAD given that age, education level, gender and English proficiency may influence the media of choice to receive health information. Conclusions: The two cohorts that were surveyed had similar and suboptimal understanding of PAD, and a community-specific strategy is needed to address such inequity, which may improve awareness of PAD and health outcomes.

Journal of Vascular Diseases doi: 10.3390/jvd3040038

Authors: Sabrina Medeiros Alexandre Rodrigues Rui Costa

Background/Objectives: Venous ulcers are the most common type of ulcerated wounds in the lower limbs and result from chronic venous insufficiency. The treatment of venous ulcers is multidisciplinary, with physiotherapy intervention serving as an adjuvant therapy in managing these wounds. This study investigated physiotherapeutic interventions for the management of venous ulcers. Methods: This was an exploratory and descriptive study using the Delphi method. The panel comprised 12 experts in wound care, including 25.0% physicians, 41.7% nurses, and 33.3% physiotherapists. Two rounds of analysis were conducted. A quantitative analysis was performed to assess the level of agreement in responses, while qualitative analysis was applied to the experts’ comments. Results: In the first round, consensus varied between 80% and 100%, and in the second round, it ranged from 83.3% to 100%. In the second round, all interventions obtained at least 80% consensus. The interventions included the use of compression therapy and therapeutic exercise: resistance training (2–3 sets of 10–25 repetitions, 3 times/day, for at least 12 weeks), aerobic exercise (at least 30 min, 3 times/week, for 12 weeks), stretching, balance training, and the use of a vibrating platform. Conclusions: Physiotherapy may be beneficial as an adjuvant therapy alongside specific local treatments for venous ulcers. Therapeutic exercise and compression therapy are commonly utilized interventions that could support overall treatment outcomes.

Journal of Vascular Diseases doi: 10.3390/jvd3040037

Authors: Sameer Mehta John Puskas Yashendra Sethi Murali Mohan Rama Krishna Reddy Om Prakash Yadava

Background and significance: The coronary artery disease (CAD) epidemic has seen a logarithmic increase in morbidity and mortality over the past decade. Cardiovascular diseases account for about 19.1 million deaths annually—with 80% of reports coming from low and middle-income countries, which have been attributed to a lack of infrastructure, human resources, and financial coverage. In tandem with the developed world, India has also seen significant growth in interventional and surgical cardiovascular care. The dominance of coronary artery bypass grafting (CABG) procedures in India has attracted the attention of the world. With this review, the authors aim to highlight the role of cardiac surgeons in India as the “unsung heroes” of coronary interventions. Observations: A pernicious atherosclerotic pathology develops in thendian population as a result of genetic and socio-cultural predispositions, which is further complicated by anatomical and physiological differences. The pathology manifests as a diffuse disease in relatively small caliber coronary arteries, necessitating the consideration of CABG over interventional procedures. Indian cardiac surgeons have stood up to the challenge and have powered health tourism to India from around the world due to the excellent success rate and long-term outcomes at a 50–80% lesser cost than most developed countries. Beyond the costs, a major highlight is the high rate of arterial bypass and off-pump surgery. These balance the unbridled exuberance of the interventional cardiology medical–industrial complex, providing a critical balance that benefits patients and improves acute and long-term outcomes. Conclusions: Indian cardiac surgery is now known globally not only for its affordability but also for the skill set and the quality of surgeons. The surgeons’ vast experience and risk-taking capacity have made them an indispensable part of the interventional cardiology team and has allowed a multidisciplinary collaboration that inspires the world. This is evident from the rising trend of medical tourism to India.

Journal of Vascular Diseases doi: 10.3390/jvd3040036

Authors: Serra Aksoy Pinar Demircioglu Ismail Bogrekci

Background/Objectives: Insufficient blood supply to the brain, whether due to blocked arteries (ischemic stroke) or bleeding (hemorrhagic stroke), leads to brain cell death and cognitive impairment. Ischemic strokes, which are more common, occur when blood flow to the brain is obstructed. Magnetic resonance imaging (MRI) scans are essential for distinguishing stroke types, but precise and timely identification of ischemic strokes is crucial for effective treatment. Manual diagnosis can be difficult due to high patient volumes and time constraints in hospitals. This study aims to investigate the use of deep learning techniques for predicting ischemic strokes with high accuracy, enabling earlier diagnosis and intervention. Methods: The study utilized advanced deep learning algorithms, specifically ConvNeXt Base, to analyze large datasets of medical imaging data, focusing on MRI scans. The model was trained and validated on a labeled dataset to identify critical indicators and patterns associated with stroke risk. The performance of the model was evaluated based on accuracy metrics to determine its predictive capabilities. Results: ConvNeXt Base achieved an overall accuracy of 84% on the validation set, demonstrating its effectiveness in identifying ischemic strokes. The model was able to detect key patterns linked to stroke risk, highlighting its potential for use in clinical settings to aid in early diagnosis and decision-making. Conclusions: ConvNeXt Base reveals promise in improving stroke prediction accuracy, enabling earlier diagnosis and personalized treatment, which could lead to faster, more effective medical interventions.

Journal of Vascular Diseases doi: 10.3390/jvd3040035

Authors: Nur Dikmen Evren Ozcinar

Background: This study evaluates the use of transbrachial artery access for endovascular treatment of iliac artery lesions, with a focus on its efficacy and safety outcomes. Methods: Between January 2020 and May 2023, 94 patients with iliac artery disease underwent endovascular procedures via a transbrachial access approach. The majority of patients (n = 68; 72%) presented with lifestyle-limiting claudication (Rutherford category 3). Diagnostic angiography identified Transatlantic Inter-Society Consensus II (TASC) C/D lesions in 54 patients (57%). The primary outcome was achieving technical success with transbrachial access, while secondary outcomes included secondary technical success (necessitating additional transfemoral access), access site complications, and cerebrovascular events. Results: The primary and secondary technical success rates were 82% and 92%, respectively. Access site-related adverse events occurred in 12 patients (12%), primarily hematomas (seven events, 7.4%; two requiring transfusion) and pseudoaneurysms (four events, 4.2%). Thrombotic occlusion was observed in one patient (1%), and brachial arterial bleeding requiring urgent surgical intervention occurred in three patients (3.2%). Neurological complications included two cerebrovascular events (2.1%), although no permanent or transient median nerve injuries were observed. Conclusions: The transbrachial approach represents a potential alternative to the femoral artery route in patients with iliac artery lesions. However, the relatively higher incidence of access site complications may limit its broader application in clinical practice.

Journal of Vascular Diseases doi: 10.3390/jvd3040034

Authors: Maria do Carmo de Alustau-Fernandes Fabíola Fialho Furtado Gouvêa Natália Tabosa Machado Calzerra Tays Amanda Felisberto Gonçalves Valéria Lopes de Assis Walma Pereira de Vasconcelos Petrônio Filgueiras de Athayde-Filho Robson Cavalcante Veras Thyago Moreira de Queiroz Isac Almeida de Medeiros

The development of new organic nitrates is still relevant due to the clinical limitations of their use. Tetrahydrofurfuryl nitrate (NTHF) is a new organic nitrate obtained through a synthetic route of sugarcane. The aim of this research was to investigate the cardiovascular effects promoted by NTHF in rats. Isolated vascular smooth muscle cells (VSMC) were incubated with a specific probe and were analyzed in a flow cytometer to measure the NO concentration after NTHF treatment. Rat superior mesenteric rings were isolated and used for isometric tension recordings and the evaluation of the vasorelaxant activity induced by NTHF. For the in vivo study, polyethylene catheters were implanted into the abdominal aorta and inferior vena cava of the rats (weighing 250–300 g). NTHF increased NO levels in rat VSMCs. In anesthetized rats, NTHF induced hypotension and bradycardia after intravenous administration. These effects were attenuated after the administration of a sGC inhibitor, methylene blue. In the phenylephrine pre-contracted superior mesenteric artery of rats, NTHF (1 pM–10 μM) induced concentration-dependent vasodilatation in both the intact and removed endothelium. Furthermore, in the presence of NO° scavenging (C-PTIO and HDX) or ODQ, a sGC inhibitor, the vasorelaxation induced by NTHF was decreased. NTHF tolerance was evaluated in mesenteric artery rings previously exposed with isolated concentrations of the new organic nitrate. The vasorelaxant effect was not modified by exposure to nitrate. These results demonstrated that NTHF induced hypotension and bradycardia in vivo and a vasorelaxant effect with the participation of the NO-sGC-PKG pathway and triggering calcium-activated K+ channels without vascular tolerance induction.

Journal of Vascular Diseases doi: 10.3390/jvd3040033

Authors: Melvin R. Hayden

The microvessel neurovascular unit, with its brain endothelial cells (BEC) and blood–brain barrier remodeling, is important in the development of impaired cognition in sporadic or late-onset Alzheimer’s disease (LOAD), which is associated with aging and is highly prevalent in older populations (≥65 years of age). It is also linked with vascular dementia and vascular contributions to cognitive impairment and dementia, including cerebral amyloid angiopathy in neurodegeneration. LOAD is considered to be the number one cause of dementia globally; however, when one considers the role of mixed dementia (MD)—the combination of both the amyloid cascade hypothesis and the vascular hypothesis of LOAD—it becomes apparent that MD is the number one cause. Microvessel BECs are the first cells in the brain to be exposed to peripheral neurotoxins from the systemic circulation and are therefore the brain cells at the highest risk for early and chronic injury. Therefore, these cells are the first to undergo injury, followed by excessive and recurrent wound healing and remodeling processes in aging and other age-related diseases such as cerebrocardiovascular disease, hypertension, type 2 diabetes mellitus, and Parkinson’s disease. This narrative review explores the intricate relationship between microvessel remodeling, cerebral small vessel disease (SVD), and neurodegeneration in LOAD. It also discusses the current understanding of how microvessel dysfunction, disruption, and pathology contribute to the pathogenesis of LOAD and highlights potential avenues for therapeutic intervention.

Journal of Vascular Diseases doi: 10.3390/jvd3040032

Authors: Ramez N. Abdalla Susanne Schnell Maria Aristova Mohamad Mohayad Alzein Yasaman Moazeni Jessie Aw Can Wu Michael Markl Donald R. Cantrell Michael C. Hurley Sameer Ansari Ali Shaibani

Background and Purpose: The cerebral circulation is highly regulated to maintain brain perfusion, keeping an equilibrium between the brain tissue, cerebrospinal fluid (CSF) and blood of the arterial and venous systems. Cerebral venous drainage abnormalities have been implicated in multiple cerebrovascular diseases. The purpose of this study is to evaluate the relationship between the arterial inflow (AI) and the cerebral venous outflow (CVO) and their correlation with the cardiac outflow in healthy adults and children to understand the role of the emissary veins in normal venous drainage. Materials and Methods: A total of 31 healthy volunteers (24 adults (39.5 ± 16.0) and seven children (3.4 ± 2.2)) underwent intracranial 4D flow with full circle of Willis coverage and 2D PC-MRI at the level of the transverse sinus for measurement of the AI and CVO, respectively. The AI was calculated as the sum of the flow values in the bilateral internal carotid and basilar arteries. The CVO was calculated as the sum of the flow values in the bilateral transverse sinuses. The cardiac outflow was measured via 2D PC-MRI with retrospective ECG gating with images acquired at the proximal ascending aorta (AAo) and descending (DAo) aorta. The ratios of the AI/AAo flow and CVO/AI were calculated to characterize the fraction of cerebral arterial inflow in relation to cardiac outflow and venous blood draining through the transverse sinuses, respectively. Results: The AI and CVO were significantly correlated (r = 0.81, p < 0.001). The CVO constituted approximately 60–70% of the AI. The CVO/AI ratio was significantly lower in children versus adults (p = 0.025). In adults, the negative correlation of the AI with age remained strong (r = −0.81, p < 0.001). However, the CVO was not significantly associated with age. Conclusion: The CVO/AI ratio suggests an important role of the emissary veins, accounting for approximately 30–40% of venous drainage. The lower CVO/AI ratio in children, although partially related to decreased AI with age, suggests a greater role of the emissary veins in childhood, which strongly decreases with age.

Journal of Vascular Diseases doi: 10.3390/jvd3040031

Authors: Vasco Starke Jürgen Wallner Robert Stigler Sidney Mannschatz Jakob Müller Erich Brenner

Background/Objectives: Head and neck free-flap reconstructions are often required to treat tumors or extensive post-traumatic jaw defects. The facial artery is the standard receiving vessel for intraoral microvascular anastomoses. However, its use is associated with several disadvantages, such as lesions of buccal nerve branches of the facial nerve or the parotid duct, as well as variability in course and diameter. The aim of this study is to investigate whether branches of the sublingual artery can be considered as an alternative intraoral supply vessel to the facial artery to avoid these drawbacks. Methods: Twelve formalin-fixed cadaveric heads with 24 sides (n = 24) were dissected. The origin, course, branching pattern, and distribution of the sublingual artery were examined. In addition, the diameters of the branches of the sublingual artery were assessed to identify potential supply vessels for anastomoses. Results: In ten of the twenty-four cases (41.7%), the sublingual artery originated from the lingual artery, and in nine cases (37.5%), the lingual artery originated from the facial artery. The main trunk of the sublingual artery was present in the floor of the mouth in all cases (100%), with a diameter of ≥0.9 mm in vitro (1 mm in vivo). In 15 of the 24 half heads (62.5%), branches of the sublingual artery with ≥0.9 mm were identified in this space, with the main branch being considerably stronger. Conclusions: The large diameter of the sublingual artery in the floor of the mandible suggests that this vessel or its branches could be considered as alternative pedicles for intraoral anastomoses in mandibular microvascular free-flap grafts.

Journal of Vascular Diseases doi: 10.3390/jvd3040030

Authors: Satomi Kagota Kana Maruyama-Fumoto Risa Futokoro Kazumasa Shinozuka

The perivascular adipose tissue (PVAT) regulates the arterial tone by releasing vasoactive molecules. PVAT dysfunction favoring the vasorelaxation response could contribute to the development of kidney disease in metabolic syndrome (MetS). Previously, we demonstrated that overactivation of angiotensin II signaling in the PVAT deteriorates the compensatory PVAT effects in rats with MetS (SHRSP.Z-Leprfa/IzmDmcr (SPZF) and SHR/NDmcr-cp (CP) rats). Apelin is an endogenous regulator of angiotensin II. Therefore, we investigated whether changes in apelin levels in the PVAT alter PVAT function and impair kidney function in MetS. Twenty-three-week-old male and female SPZF and CP rats were used. In the female CP rats, apelin mRNA levels in renal arterial PVAT, enhancing effects of the PVAT on acetylcholine-induced relaxation in renal arteries, and estimated glomerular filtration rate (eGFR) were the highest, and urine protein levels and homeostasis model assessment of insulin resistance (HOMA-IR) were the lowest. Apelin mRNA levels were positively correlated with the enhancing effects of the PVAT on vasorelaxation and eGFR but negatively correlated with urine protein levels and HOMA-IR. Moreover, apelin levels positively correlated with mRNA levels of angiotensin-converting enzyme 2 and angiotensin II type 1 receptor-associated protein, which are negative regulators of angiotensin II. This study suggests that a decline in apelin levels in the PVAT, probably owing to angiotensin II, is associated with PVAT dysfunction on vascular tone, resulting in impaired kidney function in MetS.

Journal of Vascular Diseases doi: 10.3390/jvd3040029

Authors: Helyel Rodrigues Gobbo Gabriel Marcelino Barbosa Lucas Cezar de Oliveira Gustavo Vieira de Oliveira

Purpose: This study investigated the impact of two different resistance training (RT) protocols on cardiac autonomic modulation during exercise recovery in trained individuals. It was hypothesized that a hypertrophic resistance training program would induce more significant stress and negatively affect cardiac autonomic modulation compared to a power/force resistance training program. Methods: Six healthy, trained participants (aged 18–40) were randomized in a crossover and controlled pilot study. Participants performed two RT protocols: (i) three sets of 10 repetitions with 85% of 10 RM, 60 s inter-set rest (3x1060s) and (ii) eight sets of three repetitions with 85% of 3 RM, 120 s inter-set rest (8x3120s). Heart rate variability (HRV) was measured before and 30 min after each RT session. Results: Significant reductions in HRV parameters (RMSSD, HF, and SD1) were observed following the 3x1060s protocol (hypertrophic design) compared to baseline. Conversely, the 8x3120s (power/force design) protocol did not show significant changes in HRV parameters. A significant interaction effect for time and RT protocol was found for all HRV measures with more significant reductions observed after 3x1060s compared to 8x3120s. Conclusions: The hypertrophic RT session (3x1060s) significantly reduced HRV parameters, suggesting higher physiological stress and potentially negative implications for cardiac autonomic recovery than the power/force RT session (8x3120s). These findings highlight the importance of considering exercise intensity and protocol design to manage cardiac autonomic stress during resistance training.

Journal of Vascular Diseases doi: 10.3390/jvd3040028

Authors: Natalia Do Couto Augusto Lima Luisa Rezende Rodrigo Fraga-Silva Weslley Fernandes-Braga Lucas Michelin Thiago Castro-Gomes Nikolaos Stergiopulos Luciana Andrade

Shear stress is one of the major hemodynamic forces acting on the endothelium. However, it is not well known how endothelial cells (EC) respond mechanically to these stimuli in vivo. Here we investigated whether changes in biomechanics properties and shear stress could increase cell susceptibility to injury, contributing to vascular fragility. We surgically implanted a shear stress modifier device on the carotid artery of ApoE-knockout mice (ApoE−/−), which, due to its shape, causes a gradual stenosis in the vessel, resulting in distinct shear stress patterns. Our data show actin fibers accumulation in areas with higher lipid deposition in ApoE−/−, indicating that dyslipidemia might interfere with EC actin cytoskeleton organization. We also showed that both shear stress and dyslipidemia were important for EC susceptibility to injury. Furthermore, lysosomal distribution, an important organelle for plasma membrane repair, was altered in ApoE−/−, which could compromise EC’s ability to repair from damage. Therefore, dyslipidemia and variations in shear stress patterns not only affect cellular mechanics by compromising the actin cytoskeleton organization, but also enhance cell susceptibility to injury and alter vesicle trafficking in vascular cells. This may likely contribute to vascular fragility and thus to the initial steps of atherosclerosis development.

Journal of Vascular Diseases doi: 10.3390/jvd3040027

Authors: Beatriz Almeida Melissa Mariana Margarida Lorigo Nelson Oliveira Elisa Cairrao

The term “Transgender” is used to describe individuals whose gender identity is different from their external sexual anatomy at birth. The number of people identifying as transgender has increased in recent years, and consequently, the number of gender affirmation surgeries and the use of hormonal therapies has also increased. A wide range of hormonal therapies has emerged considering the target population, age, and final outcomes, and as such these are becoming increasingly developed and complex in order to be the most appropriate for each individual. However, the side effects of these therapies remain to be fully understood. Therefore, this review aims to assess the impact of hormone therapy, in both transgender men and women of different ages, on the lipid profile. From the studies analyzed, it is possible to conclude that there is a relationship between hormone therapy and the lipid profile, with different outcomes between transgender men and women. There is a reduction in cardiovascular risk for transgender women as opposed to transgender men, in whom cardiovascular risk seems to increase due to lipid changes. It is now necessary to understand the mechanisms involved in order to reduce the consequences of these therapies and promote positive health outcomes.

Journal of Vascular Diseases doi: 10.3390/jvd3030026

Authors: Maria Soares Catarina Freitas Maria Timoteo Ana Lourenço Ana Ferreira João Figueiredo Telmo Pereira Armando Caseiro

Aging is a complex process inherent to and inevitable in humans. With life expectancy rising, there are concerns about the senior population’s wellbeing, and a hope of preventing certain diseases such as cardiovascular diseases. To achieve it, this study resorts to the implementation of an interventional program based on the comprehensive geriatric assessment model [AGA@4life]. The aim is to evaluate the effect of a new nutritional and exercise regime and evaluate possible changes in nitric oxide (NO) metabolites and endothelin 1 (ET-1). An intervention study was developed with 17 participants with ages of 65 and above. They were evaluated in the beginning [T0] and after eight weeks [T1], where NO metabolites and ET-1 levels were determined by enzymatic assays and the slot blot technique, respectively. There was a significant decrease in ET-1 levels in both the control (p < 0.001) and intervention (p = 0.04) groups from T0 to T1, but there was only a tendency for a decrease in the NO metabolite’s levels in the same conditions [p > 0.05]. Even though the NO metabolite levels did not increase as expected, possibly because of an increase in oxidative stress, the ET-1 levels decreased as expected and the overall results are promising, proving this program could have a beneficial effect on the geriatric population.

Journal of Vascular Diseases doi: 10.3390/jvd3030025

Authors: Zahra Hasanpour-Segherlou Forough Masheghati Mahdieh Shakeri-Darzehkanani Mohammad-Reza Hosseini-Siyanaki Brandon Lucke-Wold

Traumatic brain injury (TBI) results from external biomechanical forces that cause structural and physiological disturbances in the brain, leading to neuronal, axonal, and vascular damage. TBIs are predominantly mild (65%), with moderate (10%) and severe (25%) cases also prevalent. TBI significantly impacts health, increasing the risk of neurodegenerative diseases such as dementia, post injury. The initial phase of TBI involves acute disruption of the blood–brain barrier (BBB) due to vascular shear stress, leading to ischemic damage and amyloid-beta accumulation. Among the acute cerebrovascular changes after trauma are early progressive hemorrhage, micro bleeding, coagulopathy, neurovascular unit (NVU) uncoupling, changes in the BBB, changes in cerebral blood flow (CBF), and cerebral edema. The secondary phase is characterized by metabolic dysregulation and inflammation, mediated by oxidative stress and reactive oxygen species (ROS), which contribute to further neurodegeneration. The cerebrovascular changes and neuroinflammation include excitotoxicity from elevated extracellular glutamate levels, coagulopathy, NVU, immune responses, and chronic vascular changes after TBI result in neurodegeneration. Severe TBI often leads to dysfunction in organs outside the brain, which can significantly impact patient care and outcomes. The vascular component of systemic inflammation after TBI includes immune dysregulation, hemodynamic dysfunction, coagulopathy, respiratory failure, and acute kidney injury. There are differences in how men and women acquire traumatic brain injuries, how their brains respond to these injuries at the cellular and molecular levels, and in their brain repair and recovery processes. Also, the patterns of cerebrovascular dysfunction and stroke vulnerability after TBI are different in males and females based on animal studies.

Journal of Vascular Diseases doi: 10.3390/jvd3030024

Authors: Primali Rukmal Jayasooriya Hiruni Ashcharya Wijerathna Weerasinghe Liyanaarachchige Anushan Hiranya Jayasinghe Prasangi Madubhashini Peiris Wijeyapala Abeyasinghe Mudiyanselage Udari Lakshika Abeyasinghe Ruwan Duminda Jayasinghe

This review analyzes the clinicopathological features, diagnostic challenges, and clinical outcomes of 60 intraoral angiosarcoma (InO-AS) and 20 intraoral Kaposi sarcoma (InO-KS) cases. These malignancies primarily affect adults, with mean ages of 52.3 years for InO-AS and 44 years for InO-KS, and are rare in children. Both show a male predilection, with InO-KS strongly linked to HIV infection. Metastatic InO-AS typically appears smaller and is located in the mandibular or maxillary gingiva. Most InO-KS cases occur in HIV-positive individuals, often in nodular form. Histological differentiation of InO-AS from poorly differentiated carcinoma and spindle cell carcinoma requires a comprehensive panel of immunohistochemical markers such as CK, CD31, and CD34, while HHV-8 antibody and CD34 help diagnose InO-KS. Treatment for InO-AS involves surgery with radiotherapy and/or chemotherapy, while InO-KS management may include antiretroviral therapy for AIDS patients. InO-AS is aggressive, with over half of patients dying from the disease, whereas InO-KS generally has a less severe course. Despite their rarity, both InO-AS and InO-KS behave similarly to their extraoral counterparts. A key limitation noted in this review is the inconsistent histopathological reporting of AS, particularly regarding histopathological grade, which complicates the assessment and comparison of treatment outcomes.

Journal of Vascular Diseases doi: 10.3390/jvd3030023

Authors: Mohamed Ali Mohamed Noureldin Amr Elokda Ahmed Tawfik

Purpose: To compare the efficacy and safety of percutaneous mechanical debulking (PMD) using mechanical rotational atherectomy combined with paclitaxel drug-coated balloon (DCB) versus using paclitaxel DCB alone in the treatment of in-stent restenosis. Material and Methods: This is a multicentric retrospective observational study conducted over a period of 2 years from 2020 to 2022. The study included 49 patients presented with chronic limb-threatening ischemia (CLTI) associated with in-stent restenosis, either acute (<14 days), subacute (<3 months) or chronic (>3 months). The enrolled patients underwent endovascular revascularization using either PMD combined with paclitaxel DCB or paclitaxel DCB only. They were followed up for 6 months after the intervention clinically and by duplex evaluation. Results: The lesion length was about 14.2 mm in the group treated by PMD+ DCB and 9.3 mm in the group treated by DCB alone. The technical success rate was the same between the two groups. However, the follow-up after 6 months showed that patencies for PMD + DCB and DCB alone were 15 (68.2%) patients and 15 (55.6%) patients, respectively (significant p value = 0.028). Procedural-related complications for PMD + DCB are distal embolization (9%) of cases and no vessel perforation. Regarding the candidates who were treated by DCB alone, there were minor groin hematomas (11.1%), distal arterial thrombosis (11.1%) and contrast-induced nephropathy (CIN) (11.1%) cases. Conclusion: The endovascular management of in-stent restenosis using percutaneous mechanical debulking (PMD) in conjunction with paclitaxel drug-coated balloon (DCB) showed that PMD combined with DCB is a safe and effective modality for achieving recanalization. It gives a satisfactory outcome in terms of technical success, freedom from clinically driven target lesion revascularization rate (CD-TLR) and mortality. Despite these promising results, further research with a large enrolled population may be required to determine the cost/benefit.

Journal of Vascular Diseases doi: 10.3390/jvd3030022

Authors: Fei Wang Hui Zhang Kotaro Uchida Takuya Sugawara Shintaro Minegishi Hiroshi Doi Rie Nakashima-Sasaki Lin Chen Tomoaki Ishigami

Background: Recently, the arterial velocity pulse index (AVI) and arterial pressure volume index (API) have been used to evaluate arterial stiffness and endothelial function. As arterial stiffness and endothelial injury are risk factors for coronary artery disease (CAD), these two indexes are therefore expected to predict and evaluate the future risk of CAD and cardiovascular events before clinical manifestations. Methods: A total of 90 consecutive patients with coronary angiography (CAG) were enrolled. After excluding normal patients and acute coronary syndrome patients, forty-seven patients with CAD and thirty-two patients with coronary atherosclerosis, and baseline characteristics data were collected. A multifunctional blood pressure monitoring device, AVE-1500 (Shisei Datum, Tokyo, Japan), was used to measure the AVI and API before CAG, and immediately and 2 h, 24 h, and 48 h after CAG and (or) PCI in all the selected participants. Results: After adjusting for various variables using stepwise multiple linear regression analyses, we found that the AVI in the CAD subjects was significantly higher than that in the coronary atherosclerosis subjects before CAG (p = 0.02), immediately after CAG/PCI (p = 0.01), and 48 h after CAG/PCI (p = 0.01), whereas the AVI decreased 24–48 h rather than immediately after CAG/PCI in the CAD group. Moreover, we also found that the API clearly changed in both groups during the periprocedural period of CAG (p = 0.01). Conclusions: In accordance with the results, we propose that the API and AVI may be useful for predicting the early stage of CAD and may be promising as indicators to assess the effect of early revascularization.

Journal of Vascular Diseases doi: 10.3390/jvd3030021

Authors: Ketaki Mukhopadhyay Marla S. Johnston James S. Krulisky Shengping Yang Thomas R. Kimball

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a new disease entity occurring in the pediatric population two to six weeks after coronavirus exposure due to a systemic arteritis. We investigated post-hospital-discharge arterial function at short- and mid-term intervals using pulse wave velocity. We assessed associations between arterial function, left ventricular diastolic and systolic function and left ventricular mass. Materials and methods: Retrospective data collection was carried out on 28 patients with MIS-C with at least two outpatient pediatric cardiology clinic visits post hospital admission. The patients underwent assessment of systemic arterial function and cardiac function. Data included pulse wave velocity between carotid and femoral arteries and echocardiographic assessment of left ventricular systolic function (shortening and ejection fraction, longitudinal strain), diastolic function and left ventricular mass. Results: Pulse wave velocity significantly decreased from visit 1 to visit 2 (5.29 ± 1.34 m/s vs. 4.51 ± 0.91 m/s, p = 0.009). Left ventricular mass significantly decreased from visit 1 to visit 2 (42 ± 9 g/m2.7 vs. 38 ± 7 g/m2.7, p = 0.02). There was a significant negative correlation between the pulse wave velocity and E/A mitral inflow (−0.41, p < 0.05). Conclusions: Children have elevated pulse wave velocity and left ventricular mass in the short-term relative to mid-term values after hospital discharge. These results suggest that MIS-C is associated with transient systemic arterial dysfunction, which, in turn, may play a role in cardiac changes.

Journal of Vascular Diseases doi: 10.3390/jvd3030020

Authors: Nimesha N. Senadeera Chathuranga B. Ranaweera Inoka C. Perera Darshana U. Kottahachchi

Atherosclerotic coronary artery disease is a significant global health threat, impacting millions annually. Over time, plaque buildup narrows the coronary arteries, reducing blood flow to the heart muscle and resulting in myocardial ischemia. Timely diagnosis and intervention are crucial for restoring the blood flow to the heart muscle and preventing myocardial infarction. Given the limited availability of screening and diagnostic tests, the early diagnosis of myocardial ischemia remains challenging. While cardiac troponin is considered the gold standard for detecting myocardial injury, its effectiveness in identifying myocardial ischemia is limited. Ischemia-modified albumin (IMA) is a modified albumin variant that serves as a sensitive and early marker for ischemia. Despite extensive research on diagnostic applications of IMA as a biomarker for ischemia, significant gaps remain in understanding its formation, sensitive and specific detection, and precise clinical utility. This review aims to address these gaps by compiling literature on IMA discussing the latest findings on structure and formation, and detection methods. Further research is required to enhance understanding of the structure and formation of IMA, aiming to develop novel detection techniques or improve existing ones. However, currently, available sophisticated methods are associated with higher expenses and require specialized equipment and qualified personnel.

Journal of Vascular Diseases doi: 10.3390/jvd3030019

Authors: Gustavo Vieira de Oliveira Leonardo Victor Miranda de Souza Olavo João Frederico Ramos Junior Mônica Volino-Souza Thiago Silveira Alvares

Background: Evidence has demonstrated that non-habitual exercise, such as eccentric exercise, can increase reactive oxygen species and induce endothelial dysfunction, which plays a central role in the development of cardiovascular disease. Polyphenol-rich foods, such as cocoa, have been widely investigated in vascular function due to their antioxidant effect. Aims: The goal of this study was to evaluate the impact of microencapsulated cocoa (MC) polyphenols in the flow-mediated dilation (FMD) response and forearm muscle oxygenation (StO2) parameters after an eccentric exercise. Methods: Thirteen physically active adults were enrolled in a randomized, double-blind, and crossover study. FMD and StO2 were evaluated before and after 24 h, 48 h, and 72 h of eccentric exercise and MC or placebo supplementation. Results: No significant difference in FMD response and StO2 parameters was observed after MC and placebo (p > 0.05). Conclusions: A single dose of MC did not change FMD and muscle StO2 parameters after eccentric exercise in healthy individuals.

Journal of Vascular Diseases doi: 10.3390/jvd3020018

Authors: Alice Fortunati Chiara Perazzo Maria chiara Basile Maurizio Ce’ Alexis Elias Malavazos Sergio Papa Deborah Fazzini Francesco Secchi Marco Alì

Background: Perivascular adipose tissue (PVAT) attenuation has emerged as a novel biomarker for identifying high-risk arterial plaques due to its association with inflammation. Recognizing the systemic nature of atherosclerosis and its link with major cardiovascular events in coronary disease, this study evaluated PVAT attenuation in the peripheral arteries using CT imaging to expand the understanding of its diagnostic and prognostic potential. Methods: a retrospective analysis of 53 consecutive patients who underwent CT angiography, examining PVAT density across five primary peripheral arterial segments. A 5 mm region of interest adjacent to the vascular wall was analyzed by two blinded readers, with reproducibility coefficients calculated to determine the reliability of the measurements. For the statistical analyses, mean values were derived from these measurements. The patients were stratified into four groups based on the degree of arterial stenosis: <25%, 25–50%, 50–70%, and >70%. PVAT density comparisons between these groups were performed using the Kruskal–Wallis test and the pairwise Mann–Whitney U test with Holm–Bonferroni correction for multiple comparisons. Results: the Kruskal–Wallis test revealed statistically significant disparities in PVAT density across the categorically differentiated stenosis groups (p < 0.001), indicating an association between PVAT density and arterial stenosis severity. This association was especially pronounced in the external iliac, common femoral, superficial femoral, and popliteal arteries, where the p-values were consistently below 0.05. Subsequent pairwise analyses utilizing the Mann–Whitney U test with Holm–Bonferroni correction affirmed these findings, in particular for the external iliac, common femoral, superficial femoral and popliteal arteries (p < 0.05). Conclusions: our findings reinforce the correlation between increased PVAT density and the degree of arterial stenosis, supporting the clinical value of PVAT as a non-invasive biomarker for cardiovascular risk stratification and potentially guiding therapeutic interventions.