The International Journal Of Angiology[JOURNAL]
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200 papers
Menstruation-Related Angina-The Wee Hours.
Goyette S, Mishra T, Raza F … +5 more , Naqvi Z, Khan S, Khan A, Igman P, Bhat MS
Int J Angiol · 2024 Dec · PMID 39502351 · Full text
Literature reveals two kinds of menstruation-related anginas-cardiac syndrome X (CSX) and catamenial angina. CSX generally occurs in perimenopausal or postmenopausal women; catamenial angina affects females from puberty...
Literature reveals two kinds of menstruation-related anginas-cardiac syndrome X (CSX) and catamenial angina. CSX generally occurs in perimenopausal or postmenopausal women; catamenial angina affects females from puberty to menopause with existing/preexisting or predisposed to coronary artery disease. CSX involves recurring anginal-type retrosternal chest pains during exercise or rest with no significant findings on angiogram. Catamenial angina is menstruation-associated recurrent nonexertional left-sided chest pain alongside diaphoresis, hot flushes, and persistent lethargy. Pathophysiology of both anginas revolve around decreased levels of estrogen. Estrogen is known to act via genomic and nongenomic pathways on cardiomyocytes, endothelial cells, and smooth muscle cells to exert its cardioprotective effect. These cardioprotective effects could be lost during the postovulation phase and at the end of menstruation as well as during perimenopause or menopause owing to the decreased levels of estrogen. Evaluation should begin with a history and physical examination and focus on noninvasive tests such as exercise tolerance test, electrocardiogram, and echocardiogram. Reducing symptoms that cause discomfort and improving quality of life should be the main goal in management. Nitrates along with β blockers and analgesics for pain are the main pharmacologic modalities. Exercise training, smoking cessation, weight loss, and dietary changes are nonpharmacological modalities. Proper awareness and effective communication with patients or caregivers can lead to early diagnosis and treatment initiation.
Role of C-Reactive Protein, An Inflammatory Biomarker in The Development of Atherosclerosis and Its Treatment.
Prasad K
Int J Angiol · 2024 Dec · PMID 39502349 · Full text
This article deals with the role of c-reactive protein (CRP) in the development of atherosclerosis and its treatment. CRP has a predictive value in ischemic heart disease, restenosis, coronary artery disease, aortic athe...
This article deals with the role of c-reactive protein (CRP) in the development of atherosclerosis and its treatment. CRP has a predictive value in ischemic heart disease, restenosis, coronary artery disease, aortic atherosclerosis, and cerebrovascular disease. This article deals with the synthesis and mechanism of CRP-induced atherosclerosis and its treatment. CRP increases the formation of numerous atherogenic biomolecules such as reactive oxygen species (ROS), cytokines (interleukin [IL]-1β and IL-6), cell adhesion molecules (intercellular adhesion molecule-1, vascular cell adhesion molecule-1, monocyte chemoattractant protein-1, activated complement C , monocyte colony-stimulating factor, and numerous growth factors [insulin-like growth factor, platelet-derived growth factor, and transforming growth factor-β]). ROS mildly oxidizes low-density lipoprotein (LDL)-cholesterol to form minimally modified LDL which is further oxidized to form oxidized LDL. The above atherogenic biomolecules are involved in the development of atherosclerosis and has been described in detail in the text. This paper also deals with the treatment modalities for CRP-induced atherosclerosis which includes lipid-lowering drugs, antihypertensive drugs, antioxidants, aspirin, antidiabetic drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, regular physical activity, weight reduction, and stoppage of cigarette smoking. In conclusion, CRP induces atherosclerosis through increases in atherogenic biomolecules and the treatment modalities would prevent, regress, and slow the progression of CRP-induced atherosclerosis.
Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms.
Gorton AJ, Keshavamurthy S, Saha SP
Int J Angiol · 2024 Dec · PMID 39502344 · Full text
The thoracic aorta is a dynamic structure composed of the aortic root, ascending aorta, aortic arch, and descending aorta. It is subject to the pressure and volume of the cardiac cycle and susceptible to atherosclerotic...
The thoracic aorta is a dynamic structure composed of the aortic root, ascending aorta, aortic arch, and descending aorta. It is subject to the pressure and volume of the cardiac cycle and susceptible to atherosclerotic and aneurysmal changes. With these changes, the risk for acute aortic syndromes increases, thus creating the impetus for earlier interventions. The previous standard of open surgical repair has undergone a transition in recent years toward endovascular repair being favored in the descending and abdominal aortas with ongoing investigation into approaches for the ascending and aortic arch. These therapies have been shown to improve early mortality and morbidity outcomes with the caveat of more interventions compared with open surgery. We undertook this review to analyze the current data available regarding long-term outcomes in patients undergoing endovascular repair for thoracic aortic disease. The data support long-term benefit of endovascular repair for thoracic aortic disease. The primary indications identified for reintervention are endoleak and further aneurysmal degeneration. As the devices available for endovascular repair evolve, ongoing review of these outcomes will be necessary. It will also be important to trend the results as further techniques become available for endovascular repair of the ascending aorta and aortic arch.
Comparative Efficacy of Hypertension Management Strategies.
Schneider J, Alvarez-Betancourt A, Elbaz J … +3 more , Wenn P, Makaryus AN, Zeltser R
Int J Angiol · 2024 Dec · PMID 39502343 · Full text
Hypertension (HTN) is a major cardiovascular risk factor and a significant contributor to disease burden in the United States. Despite therapeutic advances, gaps remain between clinical trials and practice. This study ai...
Hypertension (HTN) is a major cardiovascular risk factor and a significant contributor to disease burden in the United States. Despite therapeutic advances, gaps remain between clinical trials and practice. This study aims to bridge those gaps by evaluating antihypertensive strategies. This was a retrospective analysis of HTN patients seen at a hospital clinic from 2016 to 2022 with 3- and 12-month follow-up appointments. Demographics, history, blood pressure (BP), and medication regimen were recorded. Treatment strategies were categorized as follows: adding medication (AM), increasing dosage (ID), switching medications (SM), dropped medications (DrM), or no change (NC). Changes in systolic blood pressure (SBP) were compared using linear regressions to assess the efficacy of HTN management. Of 873 patient charts reviewed, 332 patients were included. The AM group had an adjusted ∆SBP of -11 mm Hg at 3 months ( < 0.001) and -9 mm Hg at 12 months ( = 0.006). The ID group had an ∆SBP of -8.5 mm Hg at 3 months ( = 0.074) and -7 mm Hg at 12 months ( = 0.3). ∆SBP between the AM and ID groups was not statistically significant ( = 0.8). SM was associated with an ∆SBP of -3 mm Hg at 3 months ( = 0.6) and -3 mm Hg at 12 months ( = 0.7). There are meaningful differences in SBP reduction between antihypertensive medication adjustment strategies. AM had the greatest effect on lowering SBP, with ID having a slightly lesser effect. The difference in ∆SBP between the AM versus ID groups was not significant. While further study with a larger dataset is warranted, our findings highlight trends in the efficacy of HTN management strategies to help guide therapeutic regimens.
A Case of the Uncommon Cause of Chronic Coronary Syndrome: Coronary Fistula and Coronary Stenosis, Which One to Intervene?
Sinurat MRMP, Taofan T, Tobing DPL … +2 more , Atmadikoesoemah CA, Sinurat S
Int J Angiol · 2026 Jun · PMID 42137766 · Full text
We report a case of chronic coronary syndrome (CCS) that had two completely distinct mechanisms in one patient. We applied comprehensive diagnostic tools using noninvasive and invasive physiology and imaging tests before...
We report a case of chronic coronary syndrome (CCS) that had two completely distinct mechanisms in one patient. We applied comprehensive diagnostic tools using noninvasive and invasive physiology and imaging tests before, during, and after the intervention procedure to evaluate the outcome. The patient had previously visited many physicians and was diagnosed with noncardiac chest pain. He was referred to our department due to the increased frequency and intensity of angina pectoris. After a careful diagnosis, we found a nonsignificant stenosis (50%) in the mid-left anterior descending (mid-LAD) artery and an unexpectedly high-flow coronary artery fistula from the LAD to the main pulmonary artery (MPA). We tried a combination therapy with escalation of the anti-ischemic therapy but failed. He was rehospitalized with unstable angina pectoris. After a comprehensive physiology and imaging test, our team decided to perform fistula embolization with detachable coils and defer stenting in the mid-LAD artery. After the intervention procedure, his angina subsided, and his exercise capacity was remarkably improved. Cardiac computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) evaluation in 3 months revealed all coils in situ and improved cardiac function. We postulate that comprehensive diagnostic tools are required to select appropriate management and prevent unnecessary procedures.
A Case of Coronary Artery Aneurysm Occurring After Drug-Coated Balloon Intervention for De Novo Chronic Total Occlusion.
Syah PA, Loong CW, Dewangga R … +3 more , Wibawa K, Sumajaya IDGD, Liew HB
Int J Angiol · 2026 Mar · PMID 41705079 · Full text
Drug-coated balloons (DCBs) have been proposed as a viable alternative to drug-eluting stents (DES) for managing chronic total occlusion (CTO), reducing adverse reactions associated with DES. However, adverse events afte...
Drug-coated balloons (DCBs) have been proposed as a viable alternative to drug-eluting stents (DES) for managing chronic total occlusion (CTO), reducing adverse reactions associated with DES. However, adverse events after DCB treatment are rarely reported. We present a case of coronary artery aneurysm (CAA) formation after DCB treatment. A 55-year-old active smoker presented with exertional chest pain and positive ischemic response on the exercise stress test. Diagnostic coronary angiography revealed CTO in the mid-left anterior descending (mid-LAD) coronary artery with collateral circulation arising from the contralateral side. The patient underwent DCB treatment using a paclitaxel-coated balloon after predilatation with a noncutting balloon and a semi-compliant balloon. The final angiogram showed minimal recoil, type B coronary dissection nonflow limiting, and thrombolysis in myocardial infarction (TIMI) grade 3 flow. A follow-up coronary angiogram at 6 months revealed a fusiform aneurysm at the treated lesion with DCB. Despite the asymptomatic nature of the patient, good distal flow in the LAD, and the patient achieving a TIMI grade 3 flow, a decision was made to observe and closely monitor the patient. Despite potential risks, DCB remains a viable alternative to DES in CTO cases. Our case suggests that, although CAA occurred, it did not lead to significant adverse cardiac events. Further research is needed to understand the predictors and long-term outcomes of CAA.
Thromboangiitis Obliterans (Buerger's Disease): A Young Woman's Rare Case and Current Knowledge.
Autiero G, Padovan A, Vittone F … +2 more , Grolla E, Dalla Vestra M
Int J Angiol · 2026 Jun · PMID 42137754 · Full text
In this paper, we described the clinical features and the typical vascular imaging picture of a rare case of thromboangiitis obliterans (TAO) in a 47-year-old, young, Caucasian woman without relevant medical records exce...
In this paper, we described the clinical features and the typical vascular imaging picture of a rare case of thromboangiitis obliterans (TAO) in a 47-year-old, young, Caucasian woman without relevant medical records except for smoking habits and admitted to our Department of Internal Medicine with a necrotic lesion of the first and third toes of the right foot. After a rapid clinical and instrumental evaluation, necrotic tissue debridement was performed and the patient was treated with Iloprost infusion and antibiotics (for overlapping infection) with clinical improvement. Moreover, we summarized the current knowledge about the disease making an update and critical examination of the literature. TAO, also known as Buerger's disease, is a rare disease. In recent decades, the incidence of TAO has decreased in Europe and the United States in men but several studies have reported an increase in the prevalence of disease in women. TAO is a segmental nonatherosclerotic inflammatory disorder that involves primarily small and medium arteries, veins, and nerves of the extremities with limb ischemia, pain, claudication, ulcers, and necrosis that can lead to amputation. Smoking is considered the main risk factor, but despite that, more than 100 years have passed since the first description of the disease by Leo Buerger, and knowledge on pathogenesis, precipitating factors, and therapy remain still unclear.
Successful Endovascular Treatment of Postbiopsy AVF in Transplanted Kidneys: Lessons Learned from Two Cases in Multiorgan Transplant Recipients.
Želalić S, Šimunov B, Maksimović B … +3 more , Mužar R, Laganović M, Vidjak V
Int J Angiol · 2024 Sep · PMID 39131812 · Full text
Allograft biopsy is a cornerstone in the management of transplanted kidneys. It is a safe procedure, often performed in the outpatient setting. A rare complication is formation of a postbiopsy arteriovenous fistula (AVF)...
Allograft biopsy is a cornerstone in the management of transplanted kidneys. It is a safe procedure, often performed in the outpatient setting. A rare complication is formation of a postbiopsy arteriovenous fistula (AVF). We present here a report of two cases of postbiopsy AVFs treated endovascularly. Selective embolization is a safe and effective method of treatment of postbiopsy AVFs in renal allografts.
Are Hospital Admissions (Costs) and Mortality Rate Impacted by Guideline-driven Treatment of Heart Failure?: A Comparison between Participants in the "CorBene" CMP and Standard-care Patients on the Basis of Propensity Score Matching.
Ehling J, Noblé HJ, Gysan D … +5 more , Möller M, Goss F, Haerer W, Glück S, Bansmann PM
Int J Angiol · 2024 Sep · PMID 39131811 · Full text
Heart failure (HF) is one of the most common diagnoses on admission to hospital in Germany, and one which incurs high costs. Integrated care in case management programs (CMPs) aims to improve treatment quality in the sen...
Heart failure (HF) is one of the most common diagnoses on admission to hospital in Germany, and one which incurs high costs. Integrated care in case management programs (CMPs) aims to improve treatment quality in the sense of guideline-driven treatment, while reducing hospital admissions, hospital costs, and mortality. A total of 1,844 patient data records from 11 German statutory health insurance companies enrolled in the CMP (intervention group [IG]) were compared with 1,844 standard-care patients (control group) using propensity score matching. The two groups were assessed over three follow-up observation periods regarding the endpoints' treatment costs, hospitalization rate, indicators for treatment quality (diagnostics, physician contact), and mortality. The evaluation revealed no significant differences regarding overall costs. The IG incurred significantly higher outpatient costs, but the medication costs and inpatient costs were not significantly different. There were also no significant differences in the number of hospital admissions. Patients within the CMP had significantly more frequent contact with a cardiologist, and underwent echocardiographic examination significantly more frequently. Mortality during the first follow-up observation year was considerably more favorable for the IG. There are indications that treatment quality is improved in HF patients.
The Challenge of Managing a Primary Aortic Mural Thrombus: Outcomes and Technical Considerations.
Mendes D, Veiga C, Machado R … +2 more , Sá-Pinto P, Almeida R
Int J Angiol · 2024 Sep · PMID 39131810 · Full text
Embolization to multiple arterial beds associated with primary aortic mural thrombus (PAMT) could result in high morbidity and mortality. There are no recommendations to dictate the best management. This study aims to d...
Embolization to multiple arterial beds associated with primary aortic mural thrombus (PAMT) could result in high morbidity and mortality. There are no recommendations to dictate the best management. This study aims to describe our experience in managing this rare disease. A retrospective review of all patients affected by PAMT treated at our institution between January 2015 and December 2021 was performed. Recorded data included demographics, prothrombotic risk factors, imaging findings, clinical presentation, and treatment. Primary outcomes comprised thrombus recurrence, major amputation, and death. Thirteen patients with PAMT have been included. The median age was 52 years (36-68 years), and the male/female ratio was 1:1.6. The diagnosis of PAMT was made by computed tomography angiography (CTA) in all cases. Prothrombotic conditions were identified in 92% of cases, and most patients (92%) had thoracic PAMT. The most common presentation was acute limb ischemia after thrombus embolization (85%), requiring surgical revascularization. Anticoagulation was promptly started in all patients. Two patients developed heparin-induced thrombocytopenia. Recurrence of embolization/thrombosis was observed in 54% of patients; two underwent endovascular thrombus exclusion with a stent graft. We identified one PAMT-related death and one major amputation with a median follow-up time of 39 months (12-64 months). Anticoagulation alone as initial therapy could completely resolve PAMT but is associated with high embolization recurrence. Thoracic endovascular aortic repair is feasible and could prevent additional embolization. However, the criteria for its use as a first-line therapy still need to be defined. Our study highlights the importance of closely monitoring these patients.
Enhanced External Counterpulsation Outcomes Study: Retrospective Analyses of Data Obtained from Patients at a Single Medical Center in United States.
Akula A, Grafft HR, Tak N … +2 more , Haberman DA, Tak T
Int J Angiol · 2024 Sep · PMID 39131809 · Full text
The aim was to explore the effectiveness of enhanced external counterpulsation (EECP) therapy in patients with severe angina pectoris/ chronic heart failure symptoms, who were not suitable candidates for invasive treatme...
The aim was to explore the effectiveness of enhanced external counterpulsation (EECP) therapy in patients with severe angina pectoris/ chronic heart failure symptoms, who were not suitable candidates for invasive treatment. This retrospective study employed a comprehensive methodology that includes individualized treatment, continuous monitoring, and thorough pre- and postprogram evaluations to assess the efficacy of EECP therapy. The standard protocol involved 35 one-hour treatments, with flexibility for extensions based on therapeutic progress. When pre- and posttreatment results were analyzed, EECP improved the original functional class compared with pretreatment. The mean difference in the functional class was 1.32 (0.92), < 0.0001. Six-minute walk (6MW) distance improved from 383.6 m (110.24) to 423.1 m (121.50) with mean difference of 37.1 (44.99), < 0.0001. Duke Activity Status Index (DASI) score improved from 3.9 (2.75) to 6.0 (4.17) with mean difference of 2.16 (3.8), < 0.0001. Training metabolic equivalents (METs) improved from 3.0 (0.74) to 4.0 (1.57) with mean difference of 1.04 (1.2), < 0.0001. Weekly anginal events decreased from 13.1 (13.19) to 3.2 (7.38) with mean difference of -9.78 (11.7), < 0.0001. EECP resulted in improvement of angina pectoris functional class, the 6MW distance, reduction in the number of hospitalizations in first year posttreatment, a significant decrease in sublingual nitroglycerin use, improvement of systolic and diastolic blood pressure, and improvement of DASI score.
Pericardial Decompression Syndrome: A Comprehensive Review of a Controversial Entity.
Sarode K, Patel A, Arrington K … +2 more , Makhija R, Mukherjee D
Int J Angiol · 2024 Sep · PMID 39131808 · Full text
Pericardial decompression syndrome is an ambiguous clinical entity which has generated controversy regarding its existence. Following pericardial decompression, patients experienced clinical deterioration ranging in comp...
Pericardial decompression syndrome is an ambiguous clinical entity which has generated controversy regarding its existence. Following pericardial decompression, patients experienced clinical deterioration ranging in complications from pulmonary edema to death that could not be attributed to any other distinct clinical pathology. Multiple theories have suggested the pathophysiology behind pericardial decompression syndrome is related to preload-afterload mismatch following pericardial decompression, coronary microvascular ischemia, and stress from high adrenergic state. Our review aims to describe this syndrome by analyzing demographics, etiology of pericardial effusion, method of drainage, volume of pericardial fluid removed, time to decompensation, and clinical outcomes. A systematic review of MEDLINE/PubMed and Google Scholar literature databases were queried for case reports, case series, review articles, and abstracts published in English journals between 1983 and December 2022. Each author's interpretation of echocardiographic and/or pulmonary arterial catheterization data provided in the case reports was used to characterize ventricular dysfunction. Based on our inclusion criteria, 72 cases of pericardial decompression syndrome were included in our review. Our results showed that phenotypic heterogeneity was present based on echocardiographic findings of right/left or biventricular failure with similar proportions in each type of ventricular dysfunction. Time to decompensation was similar between immediate, subacute, and acute cases with presentation varying between hypoxic respiratory failure and shock. This review article highlights theories behind the pathophysiology, clinical outcomes, and therapeutic options in this high mortality condition.
miR-2467-3p/ABLIM1 Axis Mediates the Formation and Progression of Deep Vein Thrombosis by Regulating Inflammation and Oxidative Stress.
Qiu Y, Yang M, Che X … +2 more , Yu X, Zhi K
Int J Angiol · 2024 Sep · PMID 39131807 · Full text
Deep vein thrombosis (DVT) is a common postoperative complication of orthopaedic surgery with a complex pathogenesis mechanism. The effect of the miR-2467-3p/acting-binding LIM protein 1 (ABLIM1) axis on thrombus formati...
Deep vein thrombosis (DVT) is a common postoperative complication of orthopaedic surgery with a complex pathogenesis mechanism. The effect of the miR-2467-3p/acting-binding LIM protein 1 (ABLIM1) axis on thrombus formation and human vascular endothelial cells (HUVECs) progression was evaluated aiming to identify a novel potential biomarker of DVT. DVT rat models were established by inferior vena cava stenosis. The expression of the miR-2467-3p/ABLIM1 axis was analyzed by PCR. HUVECs were induced with oxidative low-density lipoprotein (ox-LDL). Cell growth and motility were assessed by cell counting kit 8 (CCK8) and Transwell assay. The inflammation and oxidative stress were estimated by proinflammatory cytokines and generation of MDA and reactive oxygen species (ROS). ABLIM1 was downregulated in DVT rats. Overexpressing ABLIM1 could suppress the formation of thrombosis and alleviate inflammation and oxidative stress. In HUVECs, ox-LDL induced significantly increased miR-2467-3p and decreased ABLIM1, and miR-2467-3p could negatively regulate ABLIM1. The knockdown of miR-2467-3p could alleviate the inhibited cell growth and motility by ox-LDL, and the inflammation and oxidative stress were also attenuated. While silencing could reverse the effect of miR-2467-3p on ox-LDL-induced HUVECs. The miR-2467-3p/ABLIM1 axis regulates the occurrence and development of DVT through modulating HUVECs inflammation and oxidative stress.
Postoperative Intimal Hyperplasia: Review from My Research.
Yamamura M
Int J Angiol · 2024 Sep · PMID 39131804 · Full text
Postoperative intimal hyperplasia is the major cause of the vein graft occlusion. It is very important to establish an animal model for the start of research. After my vascular surgery residency in Japan, I started my re...
Postoperative intimal hyperplasia is the major cause of the vein graft occlusion. It is very important to establish an animal model for the start of research. After my vascular surgery residency in Japan, I started my research work on postoperative intimal hyperplasia at the University of Wisconsin-Madison. My research showed that endothelial injury and monocyte infiltration is the key for postoperative intimal hyperplasia, which is very similar to Ross' pathogenesis of atherosclerosis as an inflammatory disease. Focusing on postoperative intimal hyperplasia as an inflammatory disease, especially on tumor necrosis factor-α, FR-167653 (tumor necrosis factor-α suppressive agent, inhibitor of 38 mitogen-activated protein kinase; Fujisawa Pharmaceutical Co., Ltd., Japan) is found to suppress postoperative intimal hyperplasia in a rat model by reducing serum monocyte chemoattractant protein-1 levels. However, FR-167653 is not commercially available today. Because endothelial injury is the first step of postoperative intimal hyperplasia, I investigated whether the free radical scavenger, edaravone (Radicut, Mitsubishi Tanabe Pharma Co., Japan), which alleviates the endothelial injury , can also suppress postoperative intimal hyperplasia. Moreover, the free radical scavenger edaravone (Radicut®, Mitsubishi Tanabe Pharma Co.) is also found to suppress postoperative intimal hyperplasia, by alleviating endothelial injury. In clinical settings, it is very important to detect postoperative intimal hyperplasia before its establishment. Hepatocyte growth factor is not only a hepatic growth factor but also a vascular endothelial growth factor. Recently, serum hepatocyte growth factor level was found to be a candidate biomarker for postoperative intimal hyperplasia in our rat model.
Bilateral Dolichoarteriopathies of the Internal Carotid Artery: Surgical Treatment and Results.
Dogalbayev Y, Fursov A, Sultanaliev T … +4 more , Sagandykov I, Suleimenov S, Fursov R, Ilbekova K
Int J Angiol · 2024 Sep · PMID 39131803 · Full text
The approach to surgical treatment of symptomatic bilateral dolichoarteriopathies of the internal carotid artery (DICA) remains an unresolved problem today. The aim of this article is to compare the methods of reconstruc...
The approach to surgical treatment of symptomatic bilateral dolichoarteriopathies of the internal carotid artery (DICA) remains an unresolved problem today. The aim of this article is to compare the methods of reconstruction of the stage-by-stage surgical treatment of bilateral DICA, depending on the type of deformity. The study included 30 patients with clinical manifestations of cerebrovascular insufficiency (CVI), who were found to have hemodynamically significant bilateral DICA. The patients underwent stage-by-stage operations on both sides, resulting in a total of 60 reconstructive operations on the carotid arteries. Based on the type of reconstruction, the patients were divided into three groups. All three groups showed positive dynamics with relief of the CVI clinical symptoms ( = 0.01), except for patients with persistent residual effects after strokes. Hemodynamic indices in the ICA also normalized after surgery; the linear velocity of blood flow decreased to 0.842 ± 0.087 m/s ( = 0.01) in the first group, 0.825 ± 0.057 m/s ( = 0.01) in the second group, and 0.805 ± 0.083 m/s ( = 0.01) in the third group. The results of the treatment of bilateral DICA showed that with a correctly selected approach to stage-by-stage surgical treatment, it is possible to achieve restoration of blood flow along the internal carotid artery with regression of general cerebral symptoms.
Intra-Arterial Nitroglycerin Injection in Upper Extremity Buerger's Disease for Faster Ulcer Recovery: A Case Report.
Nugroho NT, Nugraha RA, Javier RM … +2 more , Utama AJ, Pratama D
Int J Angiol · 2026 Mar · PMID 41705085 · Full text
Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a challenging nonatherosclerotic vascular disorder predominantly affecting smokers. Current management of TAO lacks standard guidelines, with smoking...
Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a challenging nonatherosclerotic vascular disorder predominantly affecting smokers. Current management of TAO lacks standard guidelines, with smoking cessation as the only cornerstone. We present the case of a 28-year-old smoker with TAO manifesting as necrotic finger ulcers. Regardless of initial debridement, conventional therapy failed to improve his condition. Angiography confirmed the diagnosis of TAO and intra-arterial nitroglycerin injection was administered, leading to immediate vasodilation and improved perfusion. Combined with oral vasodilators and anticoagulants, the patient showed significant ulcer healing within 2 weeks. TAO's etiology remains unclear; however, it is linked to smoking and immune responses. Diagnosis relies on clinical criteria and angiographic findings. While smoking cessation remains crucial, various pharmacological interventions like vasodilators show considerable potential for enhancing therapeutic outcomes. Our case highlights the potential of intra-arterial nitroglycerin in TAO management. However, further studies are warranted due to limited sample size. Advancements in understanding TAO's biology and diagnostic techniques offer hope for improved management strategies in the future.
Diagnostic Strategies in Pulmonary Embolism.
Glazier MM, Glazier JJ
Int J Angiol · 2024 Jun · PMID 38846998 · Full text
Key to the diagnosis of pulmonary embolism (PE) is a careful bedside evaluation. After this, there are three further diagnostic steps. In all patients, estimation of the clinical probability of PE is performed. The other...
Key to the diagnosis of pulmonary embolism (PE) is a careful bedside evaluation. After this, there are three further diagnostic steps. In all patients, estimation of the clinical probability of PE is performed. The other two steps are measurement of D-dimer when indicated and chest imaging when indicated. The clinical probability of PE is estimated at low, moderate, or high. The prevalence of PE is less than 15% among patients with low clinical probability, 15 to 40% with moderate clinical probability, and >40% in patients with high clinical probability. Clinical gestalt has been found to be very useful in estimating probability of PE. However, clinical prediction rules, such as Wells criteria, the modified Geneva score, and the PE rule out criteria have been advocated as adjuncts. In patients with high clinical probability, the high prevalence of PE can lower the D-dimer negative predictive value, which could increase the risk of diagnostic failure. Consequently, patients with high probability for PE need to proceed directly to chest imaging, without prior measurement of D-dimer level. Key studies in determining which low to moderate probability patients require chest imaging are the Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism (ADJUST-PE), the Simplified diagnostic management of suspected pulmonary embolism (YEARS), and the Pulmonary Embolism Graduated D-Dimer trials. In patients with low clinical probability, PE can be excluded without imaging studies if D-dimer is less than 1,000 ng/mL. In patients in whom there is not a low likelihood for PE, this can be excluded without imaging studies if the D-dimer is below the age-adjusted threshold.
Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism.
Glazier HA, Kaki A
Int J Angiol · 2024 Jun · PMID 38846997 · Full text
Massive/high-risk pulmonary embolism (PE) is associated with a 30-day mortality rate of approximately 65%. In searching for strategies that may make a dent on this dismal mortality rate, investigators have, over the last...
Massive/high-risk pulmonary embolism (PE) is associated with a 30-day mortality rate of approximately 65%. In searching for strategies that may make a dent on this dismal mortality rate, investigators have, over the last decade, shown renewed interest in the potential beneficial role of venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) in the treatment of patients with high-risk PE. There is a dearth of high-quality evidence regarding the value of ECMO in the treatment of massive PE. Studies examining this issue have generally been retrospective, often single center and frequently with small patient numbers. Moreover, these reported studies are not matched with appropriate controls, and, accordingly, it is difficult to regulate for inherent treatment bias. Not surprisingly, there are no randomized controlled trials examining the value of ECMO in the treatment of massive PE, as such trials would pose formidable feasibility challenges. Over the past several years, there has been increasing support for upfront use of V-A ECMO in the treatment of massive PE, when it is complicated by cardiac arrest. In those patients without cardiac arrest, but who have contraindications for thrombolysis, V-A ECMO combined with anticoagulation may be used to stabilize the patient. If after 3 to 5 days, such patients demonstrate persistent right ventricular dysfunction, embolectomy (either surgical or catheter based) should be performed. Well-designed, multicenter, prospective studies are urgently needed to better define the role of V-A ECMO in the treatment of patients with massive PE.
Clinical Presentation and Risk Stratification of Pulmonary Embolism.
Mohammed AQI, Berman L, Staroselsky M … +4 more , Wenn P, Hai O, Makaryus AN, Zeltser R
Int J Angiol · 2024 Jun · PMID 38846996 · Full text
Pulmonary embolism (PE) presents with a spectrum of symptoms, ranging from asymptomatic cases to life-threatening events. Common symptoms include sudden dyspnea, chest pain, limb swelling, syncope, and hemoptysis. Clinic...
Pulmonary embolism (PE) presents with a spectrum of symptoms, ranging from asymptomatic cases to life-threatening events. Common symptoms include sudden dyspnea, chest pain, limb swelling, syncope, and hemoptysis. Clinical presentation varies based on thrombus burden, demographics, and time to presentation. Diagnostic evaluation involves assessing symptoms, physical examination findings, and utilizing laboratory tests, including D-dimer. Risk stratification using tools like Wells score, Pulmonary Embolism Severity Index, and Hestia criteria aids in determining the severity of PE. PE is categorized based on hemodynamic status, temporal patterns, and anatomic locations of emboli to guide in making treatment decisions. Risk stratification plays a crucial role in directing management strategies, with elderly and comorbid individuals at higher risk. Early identification and appropriate risk stratification are essential for effective management of PE. As we delve into this review article, we aim to enhance the knowledge base surrounding PE, contributing to improved patient outcomes through informed decision-making in clinical practice.
Grayscale Inversion to aid Diagnosis of Acute Occlusive and Chronic Pulmonary Embolism on CT.
Donuru A, Torigian DA, Nachiappan AC
Int J Angiol · 2024 Jun · PMID 38846995 · Full text
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