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1.
Eur Heart J ; 45(15): 1303-1321, 2024 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-38461405

RESUMEN

All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Humanos , Claudicación Intermitente/terapia , Enfermedad Arterial Periférica/terapia , Terapia por Ejercicio/métodos , Ejercicio Físico , Europa (Continente) , Caminata
2.
Semin Thromb Hemost ; 50(6): 851-865, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38176425

RESUMEN

The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.


Asunto(s)
Tromboembolia Venosa , Humanos , Tromboembolia Venosa/etiología , Vena Cava Inferior/anomalías
3.
Artículo en Inglés | MEDLINE | ID: mdl-38467522

RESUMEN

All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

4.
Vasa ; 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39046466

RESUMEN

Background: The COVID-19 pandemic has led to significant disruptions in chronic disease care and forced people to stay at home. The effects of such issues on outpatients with lower extremity peripheral artery disease (PAD) remain unknown. Patients and methods: Single-centre, retrospective-prospective study conducted in a Swiss University Hospital. Patients with PAD were included between May 1 and July 31, 2020, with a follow-up visit at 12 months. Upon both visits, the Leriche-Fontaine PAD stage was recorded, and study participants underwent ankle-brachial index (ABI) calculation to assess limb perfusion. Functional capacities were assessed through the 6-minute walking and treadmill tests. Major adverse cardiovascular (MACE) and limb events (MALE) were recorded. Data collected during the pandemic were compared with the pre-pandemic period (January 1, 2019-April 30, 2020). Results: Overall, 259 patients were included. Mean age was 69 years and male sex was prevalent (69.1%). Odds of experiencing a degradation in PAD stage were lower during the pandemic than before (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.21-0.87; p = 0.018). No significant difference was found between periods in terms of ABI trends. Both pain-free walking time at treadmill test (p = 0.003) and maximal pain intensity at 6-minute walking test (p = 0.001) significantly improved during the pandemic. Compared with the pre-pandemic period, during the pandemic patients were hospitalized less frequently (p = 0.028) and were less likely to undergo elective limb revascularization (p<0.001). No significant difference was found between periods in terms of MALE (p = 0.311), whereas non-fatal strokes were less frequently reported during the pandemic (p = 0.043). Conclusion: In a cohort of outpatients with PAD, we found no evidence of clinical deterioration during the pandemic compared with the pre-pandemic period, though rates of adverse events were nonnegligible in both periods. In case of future pandemics, patients with PAD should be encouraged to maintain an active lifestyle while being closely monitored to avoid clinical worsening.

5.
Vasa ; 53(3): 193-203, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38651340

RESUMEN

Endovascular interventions and diagnostic examinations using iodinated contrast media (ICM) are standard of care in current vascular medicine. Although ICM use is generally considered safe, it may be associated with adverse reactions, vary from minor disturbances to rare, but severe life-threatening complications. This position paper of European Society of Vascular Medicine integrates current knowledge and summarizes the key information related to the use of intravascular ICM, serving as recommendation on prevention and management of acute, late, and very late adverse reactions. It should help the health professionals in all fields of vascular medicine to make decisions in daily practice for safe use of contrast media.


Asunto(s)
Medios de Contraste , Procedimientos Endovasculares , Humanos , Consenso , Medios de Contraste/efectos adversos , Medios de Contraste/administración & dosificación , Procedimientos Endovasculares/efectos adversos , Compuestos de Yodo/efectos adversos , Radiografía Intervencional/efectos adversos , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
6.
Vasa ; 53(2): 87-108, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38461401

RESUMEN

All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Humanos , Claudicación Intermitente/terapia , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/terapia , Terapia por Ejercicio/efectos adversos , Terapia por Ejercicio/métodos , Ejercicio Físico , Europa (Continente) , Caminata
7.
Semin Thromb Hemost ; 49(1): 34-46, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34902865

RESUMEN

The clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) in the full spectrum of patient care settings need to be elucidated. The aim of this study was to compare the clinical characteristics, treatment, and 90-day outcomes in patients diagnosed with PE while recovering from COVID-19 in the outpatient setting versus those who were diagnosed with PE while being hospitalized with COVID-19. Data from the international Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry were used. The major study outcomes were all-cause death, major bleeding, and venous thromboembolism (VTE) recurrences during the first 90 days after PE. From March 2020 to March 2021, 737 patients with COVID-19 experienced acute PE. Of these, 340 (46%) were recovering from COVID-19 as outpatients (267 patients who had been treated at home for COVID-19 and 73 discharged after being hospitalized with COVID-19). Compared with inpatients with COVID-19, those recovering in the outpatient setting upon PE were less likely to be men (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.40-0.72) and less likely to have hypertension (OR: 0.55; 95% CI: 0.41-0.74) or diabetes (OR: 0.51; 95% CI: 0.33-0.76). At 90-day follow-up, eight patients (none recovering from COVID-19 as outpatient vs. 2.4% of inpatients with COVID-19) developed recurrent VTE, 34 (1.9 vs. 7.9%) had major bleeding, and 128 (10 vs. 24%) died. On multivariable analysis, inpatients with COVID-19 were at a higher risk of major bleeding (adjusted hazard ratio [HR]: 6.80; 95% CI: 1.52-30.4) or death (adjusted HR: 2.24; 95% CI: 1.40-3.58). In conclusion, using a large multinational registry of patients with COVID-19 who experienced PE, thromboembolic episodes occurring in those recovering from COVID-19 as outpatients were associated with less ominous outcomes than inpatients with COVID-19.


Asunto(s)
COVID-19 , Embolia Pulmonar , Tromboembolia Venosa , Femenino , Humanos , Masculino , Anticoagulantes/uso terapéutico , COVID-19/complicaciones , Hemorragia/inducido químicamente , Pacientes Ambulatorios , Embolia Pulmonar/diagnóstico , Recurrencia , Sistema de Registros , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología
8.
Eur J Vasc Endovasc Surg ; 65(4): 521-527, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36592654

RESUMEN

OBJECTIVE: Patients with peripheral artery disease (PAD) have decreased muscle power, contributing to functional limitations. The sit to stand (STS) is a validated test to assess muscle power in older individuals; however, it has never been investigated in patients with PAD. The relationship between STS muscle power, and common disease related outcomes was evaluated at baseline and following supervised exercise training (SET) in patients with PAD. METHODS: This observational study investigated patients with Fontaine stage II. Before and after SET, maximum treadmill walking distance (MWD), functional performance tests (six minute walk, STS, stair climbing, habitual gait speed), and quality of life (Short Form 36 questionnaire) were assessed. Relative (W/kg) STS muscle power was calculated using a validated equation. Multiple regressions models were used. RESULTS: Ninety-five patients with PAD were included (63.1 ± 12.1 years, 67% male). Relative STS muscle power before: 2.7 W/kg, 95% confidence interval [CI] 2.5 - 2.9; after: 3.3, 95% CI 3.1 - 3.6, MWD before: 367.0 m, 95% CI 302.4 - 431.5; after: 598.4, 95% CI 515.6 - 681.3, six minute walking distance before: 418.3 metres; 95% CI 399.4 - 437.2; after: 468.8; 95% CI 452.7-484.9, stair climbing performance before: 6.8 seconds 95% CI 6.2 - 7.4); after: 5.3; 95% CI 4.9 - 5.7, habitual gait speed before: 1.10 m/s, 95% CI 1.05 - 1.14; after: 1.18, 95% CI 1.14 - 1.22 increased significantly following SET (p < .001). Similarly, physical before: 31.4, 95% CI 29.4 - 33.3; after: 35.8, 95% CI 33.9 - 37.7 and mental before: 39.5, 95% CI 37.0 - 42.0; after: 43.1, 95% CI 40.9 - 45.4 component summaries of the SF-36 also increased significantly (p < .001). Greater relative STS muscle power at baseline was significantly related to greater baseline treadmill (ß < .380; p < .002) and functional (ß < .597; p < .001) performance, and quality of life (ß < .291; p < .050). Larger increases in relative STS muscle power following SET were associated with greater improvements in functional performance (ß < .419; p < .009). CONCLUSION: The STS test is a valid clinical tool to monitor overall functional status in patients with symptomatic PAD.


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Humanos , Masculino , Anciano , Femenino , Calidad de Vida , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/terapia , Ejercicio Físico , Caminata/fisiología , Extremidad Inferior , Músculos , Rendimiento Físico Funcional , Terapia por Ejercicio
9.
Vasc Med ; 28(5): 404-411, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37642643

RESUMEN

INTRODUCTION: Functional performance is impaired in patients with peripheral artery disease (PAD). The effects of a supervised exercise training (SET) program on functional performance have yet to be clearly determined. The aim was to investigate the time-course evolution of functional performance during a 3-month SET program. METHODS: Patients with chronic symptomatic PAD participating in a 3-month SET program were investigated. Six-minute walking distance (6MWD), the stair climbing test (SCT), and the Short Physical Performance Battery (SPPB) were assessed before SET, after the first and second months of SET, and following the SET program. The ankle- and toe-brachial indices were measured before and after the SET program. RESULTS: Ninety patients with PAD (age 65.4 ± 10.2 years) were analyzed. The 6MWD significantly improved after the first (+7%, p ⩽ 0.001) and second months (+13%, p ⩽ 0.001) and following SET (+14%, p ⩽ 0.001) compared to before the SET program. The 6MWD significantly improved after the 2nd month (+6%, p ⩽ 0.001) and following SET (+7%, p ⩽ 0.001) compared to after the first month of the SET program. The SPPB score and SCT performance significantly improved after the first (SPPB score: +9%, p ⩽ 0.001; SCT: +17%, p ⩽ 0.001) and second months (SPPB score: +11%, p ⩽ 0.001; SCT: +24%, p ⩽ 0.001) and following SET (SPPB score: +12%, p ⩽ 0.001; SCT: +25%, p ⩽ 0.001) compared to before the SET program. No significant differences were observed following SET compared to the second month of the SET program. Vascular parameters did not change significantly. CONCLUSIONS: A 3-month SET program improves several components of functional performance, and adaptations mainly occur during the 1st and 2nd months of the SET program.


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Humanos , Persona de Mediana Edad , Anciano , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/terapia , Caminata , Terapia por Ejercicio , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/terapia , Ejercicio Físico , Rendimiento Físico Funcional , Prueba de Esfuerzo
10.
Nutr Metab Cardiovasc Dis ; 33(8): 1546-1555, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37270305

RESUMEN

BACKGROUND AND AIMS: The ultrasonographic detection of subclinical atherosclerosis (scATS) at carotid and femoral vascular sites using the atherosclerosis burden score (ABS) improves the risk stratification for atherosclerotic cardiovascular disease beyond traditional cardiovascular (CV) risk factors. However, its predictive value should be further enhanced. We hypothesize that combining the ABS and the Framingham risk score (FHRS) to create a new score called the FHRABS will improve CV risk prediction and prevention. We aim to investigate if incorporating the ABS into the FHRS improved CV risk prediction in a primary prevention setting. METHODS AND RESULTS: 1024 patients were included in this prospective observational cohort study. Carotid and femoral plaques were ultra-sonographic detected. Major incident cardiovascular events (MACEs) were collected. The receiver operating characteristic curve (ROC-AUC) and Youden's index (Ysi) were used to compare the incremental contributions of each marker to predict MACEs. After a median follow-up of 6.0 ± 3.3 years, 60 primary MACEs (5.8%) occurred. The ROC-AUC for MACEs prediction was significantly higher for the FHRABS (0.74, p < 0.024) and for the ABS (0.71, p < 0.013) compared to the FHRS alone (0.71, p < 0.46). Ysi or the FHRABS (42%, p < 0.001) and ABS (37%, p < 0.001) than for the FHRS (31%). Cox proportional-hazard models showed that the CV predictive performance of FHRS was significantly enhanced by the ABS (10.8 vs. 5.5, p < 0.001) and FHRABS (HR 23.30 vs. 5.50, p < 0.001). CONCLUSIONS: FHRABS is a useful score for improving CV risk stratification and detecting patients at high risk of future MACEs. FHRABS offers a simple-to-use, and radiation-free score with which to detect scATS in order to promote personalized CV prevention.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Humanos , Factores de Riesgo , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/epidemiología , Estudios Prospectivos , Grosor Intima-Media Carotídeo , Medición de Riesgo , Factores de Riesgo de Enfermedad Cardiaca
11.
Vasa ; 52(2): 81-85, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36734252

RESUMEN

Tobacco consumption is one of the most important risk factors for cardiovascular disease. Despite all efforts to curb any form of smoking, the number of e-cigarette users is still rising more than tabacco smoking decreases. E-cigarettes are often advertised as less harmful than regular cigarettes and helpful for smoking cessation. But e-cigarettes are not risk-free and their use causes vascular damage. There is concern about long-term health risks of e-cigarettes or when non-smokers use them as first nicotine contact. Furthermore, their use for smoking cessation is discussed controversially. To optimize treatment and medical counselling of current smokers and e-cigarette users, we present an evidence-based overview of the most important issues of e-cigarette use from a vascular medicine point of view. The key messages are presented as a position statement of the German Society of Vascular Medicine and endorsed by the European Society of Vascular Medicine.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Humanos , Fumar/efectos adversos , Factores de Riesgo
12.
Int J Mol Sci ; 24(2)2023 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-36674682

RESUMEN

In recent years, increasing attention has been paid to the role of neutrophils in cardiovascular (CV) disease (CVD) with evidence supporting their role in the initiation, progression, and rupture of atherosclerotic plaque. Although these cells have long been considered as terminally differentiated cells with a relatively limited spectrum of action, recent research has revealed intriguing novel cellular functions, including neutrophil extracellular trap (NET) generation and inflammasome activation, which have been linked to several human diseases, including CVD. While most research to date has focused on the role of neutrophils in coronary artery and cerebrovascular diseases, much less information is available on lower limb peripheral artery disease (PAD). PAD is a widespread condition associated with great morbidity and mortality, though physician and patient awareness of the disease remains low. To date, several studies have produced some evidence on the role of certain biomarkers of neutrophil activation in this clinical setting. However, the etiopathogenetic role of neutrophils, and in particular of some of the newly discovered mechanisms, has yet to be fully elucidated. In the future, complementary assessment of neutrophil activity should improve CV risk stratification and provide personalized treatments to patients with PAD. This review aims to summarize the basic principles and recent advances in the understanding of neutrophil biology, current knowledge about the role of neutrophils in atherosclerosis, as well as available evidence on their role of PAD.


Asunto(s)
Aterosclerosis , Trampas Extracelulares , Enfermedad Arterial Periférica , Placa Aterosclerótica , Humanos , Neutrófilos/patología , Aterosclerosis/patología , Placa Aterosclerótica/patología , Enfermedad Arterial Periférica/patología
13.
Rev Med Suisse ; 19(853): 2278-2283, 2023 Dec 06.
Artículo en Francés | MEDLINE | ID: mdl-38063445

RESUMEN

Venous thromboembolism (VTE) is one of the leading causes of mortality and morbidity worldwide, and its diagnosis and risk stratification remain a challenge. Therapy and follow-up are also essential in the management of this pathology. The aim of this article is to summarize the most recent recommendations in the diagnostic pathway, risk stratification and follow-up of the more severe and frequent forms of VTE, pulmonary embolism and deep vein thrombosis of the lower limbs.


La maladie thromboembolique veineuse (MTEV) constitue l'une des principales causes de morbimortalité dans le monde. Le diagnostic et la stratification du risque demeurent des défis importants. La thérapie et le suivi sont également essentiels dans la prise en charge de cette pathologie. Cet article résume les recommandations les plus récentes dans la démarche diagnostique, la stratification du risque et le suivi des formes les plus graves et fréquentes de MTEV, l'embolie pulmonaire et la thrombose veineuse profonde des membres inférieurs.


Asunto(s)
Embolia Pulmonar , Tromboembolia Venosa , Trombosis de la Vena , Humanos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/terapia , Estudios de Seguimiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapia , Trombosis de la Vena/etiología , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Embolia Pulmonar/complicaciones , Factores de Riesgo , Anticoagulantes/uso terapéutico
14.
Rev Med Suisse ; 19(853): 2304-2309, 2023 Dec 06.
Artículo en Francés | MEDLINE | ID: mdl-38063449

RESUMEN

Peripheral arterial disease of the lower limbs (PAD) is a widespread disease whose diagnosis and treatment are still inadequate, despite several available current national and international recommendations. Screening for PAD is recommended in patients presenting with lower limb symptoms (claudication) and in those at risk. For all patients with PAD, initial management measures include treatment of cardiovascular risk factors, lifestyle modification, exercise training and antithrombotic therapy, at least for any symptomatic PAD. Revascularization is discussed on a case-by-case basis, depending on the stage of the disease, in a multidisciplinary setting. A diagnostic algorithm for PAD is presented, together with the basic principles of comprehensive disease management.


La maladie artérielle périphérique des membres inférieurs (MAP) est une maladie très répandue dont le diagnostic et le traitement sont encore insuffisants malgré l'existence de plusieurs recommandations nationales et internationales. Le dépistage de la MAP est recommandé chez les patients présentant des symptômes au niveau des membres inférieurs (claudication) et chez les personnes à risque. La prise en charge initiale de la MAP comprend le traitement des facteurs de risque cardiovasculaire, la modification du mode de vie, l'entraînement à l'exercice physique et le traitement antithrombotique, si symptomatique. La revascularisation est discutée au cas par cas en fonction du stade de la maladie dans un cadre multidisciplinaire. Un algorithme diagnostique de la MAP ainsi que les bases de prise en charge globale de la maladie sont présentés.


Asunto(s)
Enfermedad Arterial Periférica , Humanos , Factores de Riesgo , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/terapia , Claudicación Intermitente/diagnóstico , Extremidad Inferior , Ejercicio Físico
15.
Rev Med Suisse ; 19(853): 2310-2315, 2023 Dec 06.
Artículo en Francés | MEDLINE | ID: mdl-38063450

RESUMEN

Pelvic congestion syndrome is a debilitating condition that is often under-diagnosed and under-treated, defined by chronic pelvic pain in the presence of pelvic varicose veins in women or, more rarely, in men. The differential diagnosis of chronic abdominal pain is vast and often leads to lengthy and costly diagnostic procedures. Conservative treatment is often insufficient, and embolization of pelvic varices is the treatment of choice to improve symptoms. A multidisciplinary management algorithm is proposed to facilitate the clinical path for these patients.


Le syndrome de congestion pelvienne est une maladie invalidante souvent sous-diagnostiquée et sous-traitée, définie par de douleurs pelviennes chroniques, en présence de varices pelviennes chez les femmes ou plus rarement les hommes. Le diagnostic différentiel des douleurs chroniques abdominales est vaste et mène souvent à des parcours diagnostiques longs et coûteux. Le traitement conservateur est souvent insuffisant et une embolisation des varices pelviennes est le traitement de choix pour améliorer la symptomatologie. Un algorithme de prise en charge multidisciplinaire est proposé afin de faciliter le parcours de soins de ces patients.


Asunto(s)
Dolor Crónico , Embolización Terapéutica , Várices , Humanos , Femenino , Pelvis , Resultado del Tratamiento , Síndrome , Dolor Pélvico/diagnóstico , Dolor Pélvico/etiología , Dolor Pélvico/terapia , Várices/complicaciones , Várices/diagnóstico , Dolor Crónico/terapia , Embolización Terapéutica/métodos
16.
Rev Med Suisse ; 19(853): 2298-2303, 2023 Dec 06.
Artículo en Francés | MEDLINE | ID: mdl-38063448

RESUMEN

The lymphatic vascular system is essential for maintaining a healthy balance between interstitial fluid production and transport. Dysregulation of this balance can lead to the formation of lymphedema, a pathology that is disabling and bothersome in the daily lives of the patients. Lymphofluoroscopy is an invaluable tool that provides static and dynamic images of the superficial lymphatic vessels, with diagnostic and therapeutic implications. This diagnostic tool is beginning to take its place in the field of lymphology, as it is minimally invasive and has virtually no side effects.


Le système lymphatique vasculaire est essentiel pour maintenir un bon équilibre entre la production et le transport du liquide interstitiel. Une dysrégulation de cette balance peut amener à la formation d'un lymphœdème, pathologie invalidante et gênante dans la vie quotidienne des patients. La lymphofluoroscopie est un instrument précieux qui permet, avec des images statiques et dynamiques, d'observer le système vasculaire lymphatique superficiel, avec des implications diagnostiques et thérapeutiques importantes. Cet instrument diagnostic commence à prendre sa place dans le domaine de la lymphologie, car il est peu invasif et quasiment sans effet secondaire.


Asunto(s)
Vasos Linfáticos , Linfedema , Humanos , Linfedema/diagnóstico por imagen , Linfedema/etiología , Vasos Linfáticos/diagnóstico por imagen
17.
Rev Med Suisse ; 19(853): 2292-2297, 2023 Dec 06.
Artículo en Francés | MEDLINE | ID: mdl-38063447

RESUMEN

Pathologies of the aorta are a complex cardiovascular diseases requiring multidisciplinary management coordinated by specialized centers able to ensure adequate patient volume. This article describes the care pathways, based on the most recent data of the literature, to optimize the management of aortic diseases).


Les pathologies de l'aorte sont des maladies cardiovasculaires complexes nécessitant une prise en charge multidisciplinaire et cordonnée par des centres spécialisés pouvant assurer un volume adéquat de patients. Cet article décrit la filière des soins, basée sur les données les plus récentes de la littérature, pour optimiser la prise en charge de la maladie aortique.


Asunto(s)
Enfermedades de la Aorta , Humanos , Enfermedades de la Aorta/terapia
18.
Microvasc Res ; 140: 104298, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34896377

RESUMEN

OBJECTIVE: Lipedema is a chronic and progressive disease associated with lymphatic impairment at later stages. The aim of our study was to describe the functional status and anatomy of lower limb superficial lymphatic system using indocyanine green (ICG) lymphography in patients with lipedema. METHODS: Following ICG injection at the dorsum of the foot, distance (cm) covered by the dye at 10 (T10') and 25 min (T25') was measured and normalized for limb length. If the dye did not reach the groin within 25 min, patients were classified as "drainage-needing" group (DNG). Values of fat and lean distribution assessed by dual-energy X-ray absorptiometry were extracted, and correlation analysis was performed. Furthermore, anatomical patterns of superficial lymphatics were assessed. RESULTS: Overall, 45 women were included, 25 (56%) of whom were classified as DNG. Symptoms duration was significantly associated with DNG status at multivariate analysis (odds ratio 1.07; 95% CI 1.01-1.14; p = 0.047). Moreover, Spearman's analysis showed a negative correlation between symptoms duration and T25' dye migration (r = -0.469; p = 0.037). Overall, no major anatomical lymphatic changes were found. CONCLUSIONS: Present study suggests that lymphatic functioning in patients with lipedema correlates with symptoms duration. Further research on larger cohorts should verify our findings and clarify their potential therapeutic implications. Overall, ICG lymphography may be promising technique to assess both lymphatic anatomy and functioning in patients with lipedema.


Asunto(s)
Colorantes Fluorescentes , Verde de Indocianina , Lipedema/diagnóstico por imagen , Vasos Linfáticos/diagnóstico por imagen , Linfografía/métodos , Imagen Óptica , Absorciometría de Fotón , Adiposidad , Adulto , Diagnóstico Precoz , Femenino , Humanos , Lipedema/fisiopatología , Extremidad Inferior , Vasos Linfáticos/fisiopatología , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos
19.
Vasc Med ; 27(2): 158-170, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34579581

RESUMEN

We investigated how nonpain-based exercise therapy intensity (light-to-moderate or vigorous) affects improvements in walking performance and cardiorespiratory fitness of patients with symptomatic lower-extremity peripheral artery disease (PAD). We searched the Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases up to April 2021 and included randomized controlled trials reporting training therapies targeting exercise intensity (heart rate, oxygen consumption, or perceived exertion). The main outcomes were walking performance (pain-free [PFWD] and maximal [MWD] walking distance) and cardiorespiratory fitness (V̇O2peak). Secondary subanalyses examined the training modality (walking or other modalities) and the approach (high-intensity interval or moderate-intensity training). A total of 1132 patients were included. Light-to-moderate was superior to vigorous exercise intensity in improving MWD (223 m [95% CI 174 to 271], p < 0.00001; 153 m [95% CI 113 to 193], p < 0.00001; respectively) and PFWD (130 m [95% CI 87 to 173], p < 0.00001; 83 m [95% CI 61 to 104], p < 0.00001; respectively). When training modalities were considered, walking at a vigorous intensity (272 m [95% CI 207 to 337], p < 0.00001) showed the largest improvement in MWD compared to other exercise modalities. A larger increase in V̇O2peak was observed following vigorous (3.0 mL O2·kg-1·min-1 [95% CI 2.4 to 3.6], p < 0.00001) compared to light-to-moderate (1.1 mL O2·kg-1·min-1 [95% CI 0.4 to 1.7], p = 0.001) exercise intensity. These results indicate that vigorous was less effective than light-to-moderate intensity in improving walking performance, whereas it was more effective in improving V̇O2peak. When the training modalities were considered, walking at a vigorous intensity showed the greatest improvement in MWD. (PROSPERO Registration No.: CRD42020199469).


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Terapia por Ejercicio/efectos adversos , Terapia por Ejercicio/métodos , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/terapia , Extremidad Inferior , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/terapia , Caminata
20.
Eur Heart J ; 42(39): 4013-4024, 2021 10 14.
Artículo en Inglés | MEDLINE | ID: mdl-34279602

RESUMEN

The aim of this collaborative document is to provide an update for clinicians on best antithrombotic strategies in patients with aortic and/or peripheral arterial diseases. Antithrombotic therapy is a pillar of optimal medical treatment for these patients at very high cardiovascular risk. While the number of trials on antithrombotic therapies in patients with aortic or peripheral arterial diseases is substantially smaller than for those with coronary artery disease, recent evidence deserves to be incorporated into clinical practice. In the absence of specific indications for chronic oral anticoagulation due to concomitant cardiovascular disease, a single antiplatelet agent is the basis for long-term antithrombotic treatment in patients with aortic or peripheral arterial diseases. Its association with another antiplatelet agent or low-dose anticoagulants will be discussed, based on patient's ischaemic and bleeding risk as well therapeutic paths (e.g. endovascular therapy). This consensus document aims to provide a guidance for antithrombotic therapy according to arterial disease localizations and clinical presentation. However, it cannot substitute multidisciplinary team discussions, which are particularly important in patients with uncertain ischaemic/bleeding balance. Importantly, since this balance evolves over time in an individual patient, a regular reassessment of the antithrombotic therapy is of paramount importance.


Asunto(s)
Enfermedad Arterial Periférica , Trombosis , Anticoagulantes/uso terapéutico , Aorta , Consenso , Fibrinolíticos/uso terapéutico , Humanos , Enfermedad Arterial Periférica/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/efectos adversos , Trombosis/tratamiento farmacológico , Trombosis/prevención & control
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