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Boyers D, Cruickshank M, Aucott L, Kennedy C, Manson P, Bachoo P, Brazzelli M. Automated devices for identifying peripheral arterial disease in people with leg ulceration: an evidence synthesis and cost-effectiveness analysis. Health Technol Assess 2024; 28:1-158. [PMID: 39186036 PMCID: PMC11367298 DOI: 10.3310/twcg3912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Background Peripheral artery disease is a common condition caused by narrowing/blockage of the arteries, resulting in reduced blood supply. Peripheral artery disease is associated with an increased risk of vascular complications, but early treatment reduces mortality and morbidity. Leg ulcers are long-lasting wounds, usually treated by compression therapy. Compression therapy is not suitable for people with peripheral artery disease, as it can affect the arterial blood supply. In clinical practice, people with peripheral artery disease are identified by measurement of the ankle-brachial pressure index using a sphygmomanometer and manual Doppler device. However, this method can be uncomfortable for people with leg ulcers and automated devices have been proposed as a more acceptable alternative. The objective of this appraisal was to summarise the clinical and cost-effectiveness evidence on the use of automated devices to detect peripheral artery disease in people with leg ulcers. Methods . Clinical effectiveness To identify reports of relevant studies, we searched major electronic databases and scrutinised the information supplied by the manufacturers of the automated devices under investigation. Due to the lack of evidence on people with leg ulcers, we considered evidence from studies of any design assessing automated devices versus an acceptable reference device in any population receiving ankle-brachial pressure index assessment. We summarised information on diagnostic accuracy of the automated devices and level of agreement with the reference device. For each device, when data permit, we pooled data across studies by conducting random-effects meta-analyses using a Hierarchical Summary Receiving Operating Characteristics model. Cost-effectiveness An economic model comprising a decision tree (24 weeks) and Markov models to capture lifetime costs and quality-adjusted life-years associated with venous, arterial and mixed aetiology disease in leg ulcer patients. Analyses were conducted from a United Kingdom National Health Service and Personal Social Services perspective. Costs and quality-adjusted life-years were discounted at 3.5% per year. Deterministic and several probabilistic analyses were used to capture uncertainty surrounding a range of optimistic and pessimistic assumptions about the impact of automated tests on health outcomes (ulcer healing and requirement for invasive management of arterial disease). Results . Clinical effectiveness From the 116 records retrieved by the electronic searches, we included 24 studies evaluating five devices (BlueDop Vascular Expert, BOSO ABI-System 100, Dopplex Ability, MESI ankle-brachial pressure index MD and WatchBP Office ABI). Two studies assessing people with leg ulcers found that automated devices often gave higher ankle-brachial pressure index readings than manual Doppler (underestimation of arterial disease). In the 22 studies involving people without leg ulcers, automated devices generally demonstrated good specificity and moderate specificity. Meta-analysis of 12 studies showed a pooled sensitivity of 64% (95% confidence interval 57% to 71%) and a pooled specificity of 96% (95% confidence interval 92% to 98%) for detection of peripheral artery disease. Cost-effectiveness Automated devices cost less than manual Doppler to deliver. However, increased risks of invasive treatment requirements for inappropriately compressed arterial/mixed ulcers due to false-negative results, and increased healing times due to delayed compression of false-positive test results mean that in most scenarios manual Doppler was less costly and had slightly higher quality-adjusted life-years than automated devices. Results are highly uncertain, dependent on many assumptions and should be interpreted cautiously. Limitations and conclusions The limited evidence identified for each automated device, especially in people with leg ulcers, and its clinical heterogeneity precludes any firm conclusions on the diagnostic performance and cost-effectiveness of these devices in clinical practice. Study registration This study is registered as PROSPERO CRD42022327588. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135478) and is published in full in Health Technology Assessment; Vol. 28, No. 37. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Charlotte Kennedy
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Miriam Brazzelli
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Jiang S, Liu Y, Liu J, Xie G, Zhao H, Zhao N, Wang H. The characteristics of arterial risk factors and ankle-brachial index in patients with lower extremity chronic venous diseases: results from the BEST study. INT ANGIOL 2024; 43:240-246. [PMID: 38619206 DOI: 10.23736/s0392-9590.24.05142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND The aim of our study was to explore the characteristics of the arterial risk factors and ankle-brachial index (ABI) in patients with lower extremity chronic venous disease (LECVD). METHODS A total of 2642 subjects were employed in our study. The lifestyle and clinical data were collected. The history of vascular diseases contained coronary artery disease, stroke, hypertension, and diabetes. ABI low than 0.9 was considered as lower extremity artery disease (LEAD). A series of blood indicators were measured. RESULTS Patients with ABI low than 0.9 belonged to the group of LEAD. Age, smoking, drinking, hypertension, diabetes mellitus, lipid-lowering drug, antidiabetic, total protein, total protein, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin and homocysteine were the common risk factors shared by LEAD and LECVD (P<0.05). The prevalence of LEAD in patients with LECVD was higher than those without LECVD (P<0.05). In Pearson correlation analysis, LECVD was related to LEAD (P<0.05). Before and after adjusted shared factors, as the performance of the logistic regression models, LEAD was an independent risk factor for the prevalence of LECVD (OR=2.937, 95% CI: [1.956, 4.411], P<0.001). CONCLUSIONS Our study demonstrated that an ABI lower than 0.9 is an independent risk factor for LECVD.
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Affiliation(s)
- Shangtong Jiang
- Vascular Medicine Center, Shougang Hospital, Peking University, Beijing, China
- Beijing Shijingshan District Key Clinical Specialty of Vascular Medicine, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Yue Liu
- Vascular Medicine Center, Shougang Hospital, Peking University, Beijing, China
- Beijing Shijingshan District Key Clinical Specialty of Vascular Medicine, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
| | - Jinbo Liu
- Vascular Medicine Center, Shougang Hospital, Peking University, Beijing, China
- Beijing Shijingshan District Key Clinical Specialty of Vascular Medicine, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
- Heart and Vascular Health Research Center of Peking University Clinical Research Institute (HVHRC-PUCRI), Beijing, China
| | - Gaoqiang Xie
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
- Heart and Vascular Health Research Center of Peking University Clinical Research Institute (HVHRC-PUCRI), Beijing, China
| | - Hongwei Zhao
- Vascular Medicine Center, Shougang Hospital, Peking University, Beijing, China
- Beijing Shijingshan District Key Clinical Specialty of Vascular Medicine, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
- Heart and Vascular Health Research Center of Peking University Clinical Research Institute (HVHRC-PUCRI), Beijing, China
| | - Na Zhao
- Vascular Medicine Center, Shougang Hospital, Peking University, Beijing, China
- Beijing Shijingshan District Key Clinical Specialty of Vascular Medicine, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
- Heart and Vascular Health Research Center of Peking University Clinical Research Institute (HVHRC-PUCRI), Beijing, China
| | - Hongyu Wang
- Vascular Medicine Center, Shougang Hospital, Peking University, Beijing, China -
- Beijing Shijingshan District Key Clinical Specialty of Vascular Medicine, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center (VHRC-PKUHSC), Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
- Heart and Vascular Health Research Center of Peking University Clinical Research Institute (HVHRC-PUCRI), Beijing, China
- Heart and Vascular Health Research Center of Chengdu Medical College (HVHRC-CMC), Chengdu, China
- Intelligent Heart and Vascular Health Digital Management Research Center, Health Big Data National Research Institute, Peking University, Beijing, China
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Gianesini S, De Luca L, Feodor T, Taha W, Bozkurt K, Lurie F. Cardiovascular Insights for the Appropriate Management of Chronic Venous Disease: A Narrative Review of Implications for the Use of Venoactive Drugs. Adv Ther 2023; 40:5137-5154. [PMID: 37768506 PMCID: PMC10611621 DOI: 10.1007/s12325-023-02657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
Evidence suggests that chronic venous disease (CVD) may be a cardiovascular disorder, as patients with CVD are prone to developing arterial (atherosclerosis) and venous (thromboembolism) diseases. This may be partly explained by shared risk factors. Thus, patients with CVD or cardiovascular disease require careful history-taking and physical assessment to identify coexisting pathologies and risk factors. This article summarises a symposium at the XIX World Congress of the International Union of Phlebology held in Istanbul, Turkey, in September 2022. Common pathophysiological features of CVD and cardiovascular disease are endothelial injury, hypercoagulability and systemic inflammation. In CVD, inflammation primarily affects the microcirculation, with changes in capillary permeability, vein wall and valve remodelling and increase in oxidative stress. Once patients develop symptoms/signs of CVD, they tend to reduce their physical activity, which may contribute to increased risk of cardiovascular disease. Data show that the presence of CVD is associated with an increased risk of cardiovascular disease, including peripheral arterial disease and heart failure (HF), and the risk of adverse cardiovascular events increases with CVD severity. In addition, patients with cardiovascular disease, particularly those with HF, are at increased risk of venous thromboembolism (VTE) and should be assessed for VTE risk if they are hospitalised with cardiovascular disease. Therefore, CVD management must include a multi-specialty approach to assess risk factors associated with both the venous and arterial systems. Ideally, treatment should focus on the resolution of endothelial inflammation to control both CVD and cardiovascular disease. International guidelines recommend various conservative treatments, including venoactive drugs (VADs), to improve the symptoms/signs of CVD. Micronized purified flavonoid fraction (MPFF) is a VAD, with high-quality evidence supporting its use in relieving symptoms/signs of CVD and improving quality of life. Moreover, in large-scale observational studies, MPFF has shown superior effectiveness in real-world populations compared with other VADs. Video Abstract. (MP4 97173 kb).
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Affiliation(s)
- Sergio Gianesini
- Translational Medicine Department, University of Ferrara, Via Porta a Mare 11, 45100, Ferrara, Rovigo, Italy.
| | - Leonardo De Luca
- Division of Cardiology, Department of Cardio-Thoracic and Vascular Medicine and Surgery, A.O. San Camillo-Forlanini, Rome, Italy
| | - Toni Feodor
- Medical Center for Diagnosis, Ambulatory Treatment and Medical Prevention, Surgery Clinic 'Sf. Nicolae', Bucharest, Romania
| | - Wassila Taha
- Non-Invasive Vascular Laboratory, AlSalam Hospital Mohandessin, Cairo, Egypt
| | - Kursat Bozkurt
- Department of Cardiovascular Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fedor Lurie
- Jobst Vascular Institute, Toledo, OH, USA
- Division of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
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Stanek A, Mosti G, Nematillaevich TS, Valesky EM, Planinšek Ručigaj T, Boucelma M, Marakomichelakis G, Liew A, Fazeli B, Catalano M, Patel M. No More Venous Ulcers-What More Can We Do? J Clin Med 2023; 12:6153. [PMID: 37834797 PMCID: PMC10573394 DOI: 10.3390/jcm12196153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most severe complication caused by the progression of chronic venous insufficiency. They account for approximately 70-90% of all chronic leg ulcers (CLUs). A total of 1% of the Western population will suffer at some time in their lives from a VLU. Furthermore, most CLUs are VLUs, defined as chronic leg wounds that show no tendency to heal after three months of appropriate treatment or are still not fully healed at 12 months. The essential feature of VLUs is their recurrence. VLUs also significantly impact quality of life and could cause social isolation and depression. They also have a significant avoidable economic burden. It is estimated that the treatment of venous ulceration accounts for around 3% of the total expenditure on healthcare. A VLU-free world is a highly desirable aim but could be challenging to achieve with the current knowledge of the pathophysiology and diagnostic and therapeutical protocols. To decrease the incidence of VLUs, the long-term goal must be to identify high-risk patients at an early stage of chronic venous disease and initiate appropriate preventive measures. This review discusses the epidemiology, socioeconomic burden, pathophysiology, diagnosis, modes of conservative and invasive treatment, and prevention of VLUs.
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Affiliation(s)
- Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
| | - Giovanni Mosti
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Angiology Department, MD Barbantini Clinic, Via del Calcio 2, 55100 Lucca, Italy
| | - Temirov Surat Nematillaevich
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Specialized Surgery, Central Hospital of Ministry of Internal Affairs, Chimboy St. 2 A, Almazar District, Tashkent 100095, Uzbekistan
| | - Eva Maria Valesky
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Tanja Planinšek Ručigaj
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Dermatovenereological Clinic, University Medical Centre Ljubljana, Gradiskova 10 Street, 1000 Ljubljana, Slovenia
| | - Malika Boucelma
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Internal Medicine, University of Algiers, Bachir Mentouri Hospital, Algiers 16208, Algeria
| | - George Marakomichelakis
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- 4th Department of Internal Medicine, General Hospital of Evangelismos, 16676 Athens, Greece
| | - Aaron Liew
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Medicine, Portiuncula University Hospital, University of Galway, H91 TK33 Galway, Ireland
| | - Bahar Fazeli
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Mariella Catalano
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Biomedical, Clinical Sciences L Sacco Hospital, Inter-University Research Center on Vascular Disease, University of Milan, 20157 Milan, Italy
| | - Malay Patel
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Vascular Surgery, Apollo CVHF, Heart Institute, Ahmedabad 380059, India
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Ramsey DJ, Kwan JT, Sharma A. Keeping an eye on the diabetic foot: The connection between diabetic eye disease and wound healing in the lower extremity. World J Diabetes 2022; 13:1035-1048. [PMID: 36578874 PMCID: PMC9791566 DOI: 10.4239/wjd.v13.i12.1035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic eye disease is strongly associated with the development of diabetic foot ulcers (DFUs). DFUs are a common and significant complication of diabetes mellitus (DM) that arise from a combination of micro- and macrovascular compromise. Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing, immune dysregulation, peripheral vascular disease, and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation. Diabetic retinopathy (DR) is caused by cumulative damage to the retinal mic-rovasculature from hyperglycemia and other diabetes-associated factors. The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation. Like the lower extremity, the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility, cause optic neuropathy, or result in partial or complete blindness. Additionally, poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma, both serious, vision-threatening conditions. Finally, diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular, sensory, and immunologic compromise. Notably, alterations in serum biomarkers, such as hemoglobin A1c, ceruloplasmin, creatinine, low-density lipoprotein, and high-density lipoprotein, are associated with both DR and DFUs. Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage. The frequent co-occurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.
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Affiliation(s)
- David J Ramsey
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - James T Kwan
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Arjun Sharma
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
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Ribieras AJ, Ortiz YY, Li Y, Huerta CT, Le N, Shao H, Vazquez-Padron RI, Liu ZJ, Velazquez OC. E-Selectin/AAV2/2 Gene Therapy Alters Angiogenesis and Inflammatory Gene Profiles in Mouse Gangrene Model. Front Cardiovasc Med 2022; 9:929466. [PMID: 35783833 PMCID: PMC9243393 DOI: 10.3389/fcvm.2022.929466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
For patients with chronic limb-threatening ischemia and limited revascularization options, alternate means for therapeutic angiogenesis and limb salvage are needed. E-selectin is a cell adhesion molecule that is critical for inflammation and neovascularization in areas of wound healing and ischemia. Here, we tested the efficacy of modifying ischemic limb tissue by intramuscular administration of E-selectin/AAV2/2 (adeno-associated virus serotype 2/2) to modulate angiogenic and inflammatory responses in a murine hindlimb gangrene model. Limb appearance, reperfusion, and functional recovery were assessed for 3 weeks after induction of ischemia. Mice receiving E-selectin/AAV2/2 gene therapy had reduced gangrene severity, increased limb and footpad perfusion, enhanced recruitment of endothelial progenitor cells, and improved performance on treadmill testing compared to control group. Histologically, E-selectin/AAV2/2 gene therapy was associated with increased vascularity and preserved myofiber integrity. E-selectin/AAV2/2 gene therapy also upregulated a panel of pro-angiogenic genes yet downregulated another group of genes associated with the inflammatory response. This novel gene therapy did not induce adverse effects on coagulability, or hematologic, hepatic, and renal function. Our findings highlight the potential of E-selectin/AAV2/2 gene therapy for improving limb perfusion and function in patients with chronic limb-threatening ischemia.
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Affiliation(s)
- Antoine J. Ribieras
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Yulexi Y. Ortiz
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Yan Li
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carlos T. Huerta
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nga Le
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Hongwei Shao
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Roberto I. Vazquez-Padron
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Zhao-Jun Liu
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL, United States
- Zhao-Jun Liu
| | - Omaida C. Velazquez
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Omaida C. Velazquez
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Veit-Haibach P, Huellner MW, Banyai M, Mafeld S, Heverhagen J, Strobel K, Sah BR. CT perfusion in peripheral arterial disease-hemodynamic differences before and after revascularisation. Eur Radiol 2021; 31:5507-5513. [PMID: 33547479 PMCID: PMC8270809 DOI: 10.1007/s00330-021-07692-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/16/2020] [Accepted: 01/18/2021] [Indexed: 12/31/2022]
Abstract
Objectives The purpose of this study was the assessment of volumetric CT perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) before and after interventional revascularisation. Methods Twenty-nine consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularisation were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment, before and after intervention. Ankle-brachial pressure index (ABI) was determined. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters were assessed with non-parametric tests. Results The cohort consisted of 24 subjects with an occlusion, and five with a high-grade stenosis. The mean blood flow before/after (BFpre and BFpost, respectively) was 7.42 ± 2.66 and 10.95 ± 6.64 ml/100 ml*min−1. The mean blood volume before/after (BVpre and BVpost, respectively) was 0.71 ± 0.35 and 1.25 ± 1.07 ml/100 ml. BFpost and BVpost were significantly higher than BFpre and BVpre in the treated limb (p = 0.003 and 0.02, respectively), but not in the untreated limb (p = 0.641 and 0.719, respectively). Conclusions CTP seems feasible for assessing hemodynamic differences in calf muscles before and after revascularisation in patients with symptomatic PAD. We could show that CTP parameters BF and BV are significantly increased after revascularisation of the symptomatic limb. In the future, this quantitative method might serve as a non-invasive method for surveillance and therapy control of patients with peripheral arterial disease. Key Points • CTP imaging of the lower limb in patients with symptomatic PAD seems feasible for assessing hemodynamic differences before and after revascularisation in PAD patients. • This quantitative method might serve as a non-invasive method, for surveillance and therapy control of patients with PAD. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07692-5.
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Affiliation(s)
- Patrick Veit-Haibach
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Department of Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada.,Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin Banyai
- Department of Internal Medicine, Subdivision of Angiology, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Mafeld
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Johannes Heverhagen
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Bert-Ram Sah
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland. .,Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland. .,Department of Cancer Imaging, King's College London, London, UK.
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