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Clinical Challenges in Peripheral Artery Disease
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Clinical Challenges in Peripheral Artery Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 5 December 2024 | Viewed by 2415

Special Issue Editor

Prof. Dr. Jeffrey L. Anderson

E-Mail Website
Guest Editor
Intermountain Medical Center Heart Institute, 5171 So. Cottonwood Street, Building 1, 5th floor, Murray, UT 84107, USA
Interests: cardiovascular risk assessment and prevention (coronary calcium screening, lipid lowering, etc.); coronary artery disease; cardiomyopathies; CV genetics and -omics; arrhythmias and electrophysiology

Special Issue Information

Dear Colleagues,

Peripheral arterial disease (PAD) is a common cardiovascular (CV) condition with important health consequences. It is estimated that PAD affects over 200 million people worldwide, adversely impacting morbidity, mortality, and quality of life. In clinical ASCVD trials, subset with PAD has consistently shown a worse natural history. However, aggressive preventive treatment can lead to an important improvement in outcome.

The clinical presentation of PAD may vary from asymptomatic to atypical leg symptoms (requiring diagnostic vigilance), as well as to classic claudication, non-healing wounds, and critical limb ischemia (CLI). Special attention is appropriate for those over age 65, for those with risk factors for atherosclerotic cardiovascular disease (ASCVD), i.e., smoking, diabetes, hypertension, hyperlipidemia, and those with ASCVD in another vascular bed. Diagnosis is typically made or confirmed by physical examination and non-invasive testing (i.e., ankle brachial index (ABI) determination, Duplex ultrasound), which may lead to CTA or MRA of the lower extremities. Invasive angiography is reserved for CLI and when revascularization is considered. Standard medical therapies include antiplatelets, statins, antihypertensives, antidiabetics, smoking cessation, and structured exercise. Optimal use of anticoagulants is still being defined. Revascularization is reserved for those with an inadequate response to medical therapy.

There are many unmet needs and future directions for PAD. Improving prognosis must begin with a better understanding of vascular biology and pathology, which can identify additional targets for the prevention and treatment of native disease and for restenosis after vascular intervention. Papers which focused on advances in PAD diagnostics are also welcomed. Improved medical options for relief of claudication are needed. Advances are envisioned in the selection and combination of antiplatelets and anticoagulants and their relative medical and cost effectiveness. Progress in lifestyle interventions to augment statins and other medical therapies will be useful. Additional trials of the various revascularization options and techniques (angioplasty and stenting or surgical bypass with vein or synthetic grafts) are needed, as well as for whom amputation should be reserved. Progress in PAD has been steady and rewarding over the past two decades, but prevention, diagnosis, and treatment  are still suboptimal, so ongoing advances are essential to optimizing PAD outcomes. This Special Issue of the Journal of Clinical Medicine addresses several of these critical areas in understanding, preventing, and treating PAD.

Prof. Dr. Jeffrey L. Anderson
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral arterial disease
  • PAD
  • critical limb ischemia
  • invasive angiography
  • antiplatelets and anticoagulants
  • revascularization
  • surgical bypass

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Related Special Issue

Published Papers (2 papers)

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Research

9 pages, 508 KiB  
Article
Adverse Events in Open Surgical vs. Ultrasound-Guided Percutaneous Brachial Access for Endovascular Interventions
by Evren Ozcinar, Nur Dikmen, Ahmet Kayan, Cagdas Baran and Levent Yazicioglu
J. Clin. Med. 2024, 13(14), 4179; https://doi.org/10.3390/jcm13144179 - 17 Jul 2024
Viewed by 542
Abstract
Background: Advances in endovascular interventions have made endovascular approaches the first option for treating peripheral arterial diseases. Although radial artery access is commonly used for coronary procedures, the common femoral artery remains the most frequent site for endovascular treatments due to better ergonomics [...] Read more.
Background: Advances in endovascular interventions have made endovascular approaches the first option for treating peripheral arterial diseases. Although radial artery access is commonly used for coronary procedures, the common femoral artery remains the most frequent site for endovascular treatments due to better ergonomics and proven technical success. Meanwhile, data on using upper extremity access via the brachial artery during complex endovascular aortic interventions are lacking. This study aimed to compare the incidence of access site complications between ultrasound-guided percutaneous brachial access (UPA) and open surgical incisional brachial access (OSA) in the management of peripheral arterial diseases. Methods: Patients who underwent treatment for peripheral arterial and aortic disease using brachial access from 2019 to 2023 were included in this study. The primary endpoint was the complication rate at the access site 30 days postoperatively. Access-related complications included bleeding requiring re-exploration, acute upper limb ischemia, thrombosis, pseudoaneurysm, arteriovenous fistula, and nerve injury associated with the brachial access. Results: Brachial access was performed on 485 patients (UPA, n = 320; OSA, n = 165). The mean operation time was 164.5 ± 45.4 min for the percutaneous procedure and 289.2 ± 79.4 min for the cutdown procedure (p = 0.003). Postprocedural hematoma occurred in 15 patients in the UPA group and 2 patients in the OSA group (p = 0.004). Thromboembolic events were observed in 9 patients in the percutaneous group and 3 patients in the OSA group. Reoperation was required for 23 patients in the percutaneous group and 8 patients in the cutdown group. Conclusions: The findings indicate that patients undergoing endovascular arterial interventions have a higher rate of brachial access complications in the UPA group compared to the OSA group. Full article
(This article belongs to the Special Issue Clinical Challenges in Peripheral Artery Disease)
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11 pages, 663 KiB  
Article
Peripheral Blood Mononuclear Cells: A New Frontier in the Management of Patients with Diabetes and No-Option Critical Limb Ischaemia
by Marco Meloni, Laura Giurato, Aikaterini Andreadi, Ermanno Bellizzi, Alfonso Bellia, Davide Lauro and Luigi Uccioli
J. Clin. Med. 2023, 12(19), 6123; https://doi.org/10.3390/jcm12196123 - 22 Sep 2023
Cited by 3 | Viewed by 1574
Abstract
The current study aimed to evaluate the effectiveness of peripheral blood mononuclear cell (PB-MNC) therapy as adjuvant treatment for patients with diabetic foot ulcers (DFUs) and no-option critical limb ischaemia (NO-CLI). The study is a prospective, noncontrolled, observational study including patients with neuro-ischaemic [...] Read more.
The current study aimed to evaluate the effectiveness of peripheral blood mononuclear cell (PB-MNC) therapy as adjuvant treatment for patients with diabetic foot ulcers (DFUs) and no-option critical limb ischaemia (NO-CLI). The study is a prospective, noncontrolled, observational study including patients with neuro-ischaemic DFUs and NO-CLI who had unsuccessful revascularization below the ankle (BTA) and persistence of foot ischaemia defined by TcPO2 values less than 30 mmHg. All patients received three cycles of PB-MNC therapy administered through a “below-the-ankle approach” in the affected foot along the wound-related artery according to the angiosome theory. The primary outcome measures were healing, major amputation, and survival after 1 year of follow-up. The secondary outcome measures were the evaluation of tissue perfusion by TcPO2 and foot pain defined by the numerical rating scale (NRS). Fifty-five patients were included. They were aged >70 years old and the majority were male and affected by type 2 diabetes with a long diabetes duration (>20 years); the majority of DFUs were infected and nearly 90% were assessed as gangrene. Overall, 69.1% of patients healed and survived, 3.6% healed and deceased, 10.9% did not heal and deceased, and 16.4% had a major amputation. At baseline and after PB-MNC therapy, the TcPO2 values were 17 ± 11 and 41 ± 12 mmHg, respectively (p < 0.0001), while the pain values (NRS) were 6.8 ± 1.7 vs. 2.8 ± 1.7, respectively (p < 0.0001). Any adverse event was recorded during the PB-MNC therapy. Adjuvant PB-MNC therapy seems to promote good outcomes in patients with NO-CLI and neuro-ischaemic DFUs. Full article
(This article belongs to the Special Issue Clinical Challenges in Peripheral Artery Disease)
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