The Presence of Simple Renal Cysts Is Associated With Increased Arterial Stiffness in Patients With Abdominal Aortic Aneurysm.

Simple renal cysts (SRC) are associated with the development of abdominal aortic aneurysms (AAA). We hypothesized that patients with AAA and SRC have increased arterial stiffness (AS) compared with patients without SRC. Patients (n=223) with an infrarenal AAA undergoing pulse wave analysis were recruited. Brachial-ankle pulse wave velocity (PWV) was measured (automated oscillometric method) as an index of AS. Participants were categorized into those with increased AS and those with normal/borderline AS (threshold: 1800 cm/s); 134 patients (60.1%) had increased AS and 89 (39.9%) patients had normal/borderline AS. Multivariable analyses showed that age ≥75 years (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.51-5.72; P=.002), systolic blood pressure ≥140 mmHg (OR, 5.05; 95% CI, 2.35-10.83; P<.001), hypertension (OR, 2.28; 95% CI, 1.08-4.79; P=.030), and presence of SRC (OR, 1.89; 95% CI, 1.03-3.46; P=.040) were independent risk factors for increased AS. The presence of SRC is an independent risk factor for increased AS in patients with an AAA. This association suggests that patients with SRC may have severe aortic wall degeneration and thus the presence of SRC may be pathologically linked to the development of AAA.

Association of preoperative pulse wave velocity to aneurysm sac shrinkage after endovascular aneurysm repair.

BACKGROUND: Arterial stiffness may be the underlying cause of divergent sac behavior after endovascular aortic repair (EVAR). We evaluated arterial stiffness using pulse wave velocity (PWV) in patients undergoing EVAR for abdominal aortic aneurysm (AAA) to determine whether arterial stiffness predicts sac behavior after EVAR. METHODS: One hundred nineteen patients with infrarenal AAA undergoing EVAR between November 2013 and July 2019 were included in this study. Preoperative brachial-ankle PWV was measured using an automated oscillometric method at our Vascular Laboratory. PWV and other risk factors were assessed with respect to being a risk factor for sac shrinkage at 2 years postoperatively. RESULTS: Univariable and multivariable analyses revealed both preoperative PWV (odds ratio [OR]=0.87; 95% confidence interval [CI]: 0.79-0.98; P=0.045) and the incidence of operative type II endoleak (OR 0.68; 95% CI 0.10-0.81; P=0.048) as independent risk factors for sac shrinkage at 2 year postoperatively. The receiver-operating characteristic curve analysis showed that the optimal cut-off value for predicting sac shrinkage was 17.79 m/s, and significantly predicted sac shrinkage. CONCLUSIONS: Preoperative PWV was independently associated with sac shrinkage after EVAR, suggesting that arterial stiffness may be one of the key factors for determining sac behavior after EVAR.

Bioelectrical impedance analysis of leg edema and its association with venous functions in patients with saphenous varicose veins.

BACKGROUND: To quantitatively evaluate edema of the lower legs in patients with saphenous varicose veins, and to determine the association between leg edema and venous hemodynamics of the lower legs. METHODS: The data of 140 patients with saphenous varicose veins in Eniwa Midorino Clinic from April 2018 to November 2019 were retrospectively analyzed. Body composition values, including Body Mass Index, extracellular water/total body water (ECW/TBW) ratio of each leg, and skeletal muscle mass of each leg, were measured by segmental multi-frequency bioelectrical impedance analyzer. Overall venous hemodynamics of the leg, including functional venous volume, venous filling index (VFI), and ejection fraction, were assessed using air-plethysmography. Saphenous and deep vein reflux were evaluated by duplex scan. RESULTS: A total of 140 patients (58 men and 82 women) with a mean age of 66.0 years (range, 21 to 84 years) were analyzed. On visual inspection, 204 legs had saphenous-type varicose veins, while 76 legs did not. The legs were divided into two groups according to the presence or absence of leg edema, which was defined as ECW/TBW ≥0.390 and <0.390, respectively; 178 legs had leg edema and the remaining 102 legs had no leg edema. In univariate analysis, there were significant differences in age, sex, the presence of saphenous varicose veins, hypertension, and VFI between legs with edema and those without edema. Multivariable logistic regression analysis for leg edema detected age, female, and VFI as an independent risk factor for leg edema. CONCLUSIONS: Leg edema was objectively evaluated by bioelectrical impedance analysis in patients with saphenous varicose veins. Older age, female, and increased venous reflux were identified as independent risk factors for leg edema.

Influence of Superficial Venous Ablation on Deep Venous Dilation and Reflux in Patients With Saphenous Varicose Veins.

BACKGROUND: To investigate the influence of superficial venous ablation on deep venous dilation and reflux in patients with saphenous varicose veins, and to elucidate the association between superficial venous reflux and deep venous morphology and hemodynamics. METHODS: The data of 154 patients with 223 limbs, who underwent endovenous radiofrequency ablation (RFA) of the great saphenous vein for primary varicose veins between September 2014 and March 2016 in Eniwa Midorino Clinic, were retrospectively analyzed. Overall venous hemodynamics of the leg, including functional venous volume (VV) and venous filling index (VFI), was assessed using air-plethysmography. Saphenous and deep vein reflux and diameter were evaluated with duplex scanning. RESULTS: Hemodynamic and morphologic changes were evaluated before and 1 month after RFA. The VV and VFI were significantly decreased in postoperative values than in preoperative values (P < .001). Limbs with deep venous reflux significantly decreased postoperatively than preoperatively (P < .001). There were significant differences in the diameter of the common femoral vein (CFV) and popliteal vein (PV) between the preoperative and postoperative values (P < .001). There were strong to moderate correlations between the VV and the diameter of the CFV or PV (CFV, r = 0.47, P < .001; PV, r = 0.35, P < .001), while there were moderate to weak correlations between the VFI and the diameter of the CFV or PV (CFV, r = 0.23, P < .001; PV, r = 0.33, P <.001). CONCLUSIONS: Superficial venous ablation significantly reduced deep venous dilation and reflux in patients with saphenous varicose veins. Significant correlations existed between the VV or VFI, which reflected superficial venous reflux, and the diameter of the deep veins. These findings reveal that volume overload due to superficial venous reflux is associated with deep venous morphology and hemodynamics.