Fatal Course of Cutaneous Cholesterol Embolization Syndrome: A Case Report

Cholesterol embolization syndrome is an increasing but underestimated problem after endovascular intervention or after the start of thrombolytic therapies. Embolies from the aortic wall involves abdominal organs and the skin of the lower extremities or buttocks. In our case a progressive ulceration and necroses occurs spontaneously. Endovascular treatment of the lower extremities was successful for a short period. Due to the progression of necrosis, both legs were amputated. Biopsies were taken from the skin were initially no directions to the diagnosis of Cholesterol embolization syndrome. After a second elliptical excision biopsy the diagnosis of cholesterol embolization syndrome was confirmed. Because the rapid progression of skin necroses despite the treatment of prednisone, patient died due to sepsis and renal failure. This case shows when arterial revascularization is performed and progression in skin necrosis occurs despite optimal arterial vascular status the diagnosis CES should be considered and treated in an early state of disease.

Choroidal Vascularity Index in Adult-Onset Foveomacular Vitelliform Dystrophy: A Pilot Study

This pilot study aims to investigate choroidal vascular status in eyes with adult-onset foveomacular vitelliform dystrophy (AOFVD), early age-related macular degeneration (AMD), and age-matched controls. In this retrospective study, choroidal thickness (CT) was measured manually using spectral domain optical coherence tomography images of the fovea, and 500 and 1500 µm from the nasal and temporal regions in the fovea. The horizontal B-scan was imported into Fiji software. Choroidal vascularity index (CVI) and luminal and stromal areas were calculated. A total of 36 eyes from 36 patients, including 18 eyes with AOFVD and 18 eyes with CD, and 16 eyes of healthy subjects were included. CVI was significantly different among subgroups (ANOVA, p = 0.004). Eyes with AOFVD presented a higher CVI (+0.03 ± 0.01, p = 0.001) than eyes with CD and controls (p = 0.03). No differences in CVI were detected between controls and eyes with CD (p = 0.25). AOFVD eyes accounted for the greatest luminal area, particularly significant in comparison with healthy controls (+0.27 ± 0.11, p = 0.02). AOFVD eyes present a greater CVI than eyes with CD and controls. The major choroidal involvement is on the luminal component, further corroborating a possible role of the choroidal vasculature in the pathological manifestations of AOFVD disease.

Peripheral oscillometric arterial performance does not depict coronary status in patients with type 2 diabetes mellitus

Background Arterial stiffness is associated with cardiovascular events. Matrix metalloproteases (MMPs), their tissue inhibitors (TIMPs) and galectin-3 are involved in the pathogenesis of end organ damage. This study aimed to evaluate the contribution of arterial stiffness, MMPs, TIMPs and galectin-3 with the current vascular status in type 2 diabetes mellitus (T2DM). Methods 74 patients with T2DM, 36 with coronary heart disease (CHD) (T2DM + CHD) and 38 without CHD (T2DM − CHD) were included. Aortic pulse wave velocity (PWVao), aortic and brachial augmentation indices (AIx aortic and AIx brachial) and central-aortic blood pressure values were determined by non-invasive arteriography. MMPs, TIMPs and galectin-3 plasma concentrations were analysed by ELISA. Results Patients with T2DM and CHD presented with significantly increased arterial stiffness determined as AIx and significantly elevated values for TIMP-4 and galectin-3. Heterogeneous peripheral vascular status regardless of the CHD status was observed, and increasing severity of CHD was associated with an increased arterial stiffness. TIMP-4 correlated significantly with an elevated PWVao in the whole cohort independently from CHD status. Conclusion Determination of arterial stiffness is an effective and, compared to laboratory markers, more reliable method for determining the peripheral vascular situation in patients with T2DM, but it does not clearly depict coronary situation.

Functional versus morphological assessment of vascular age in patients with coronary heart disease

Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VAPWVao in 68% of patients; for VAAIao in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VAtotal-cIMT accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.

VAVASC study: Clinical trial protocol

Background: VAVASC study (Validation of Arterio Venous Access Stage Classification) is a multicentre, international, prospective study. The study aims to validate the AVAS classification, which is a classification system describing vascular status of patients indicated for creation of arteriovenous access on the upper limb. Methods: Observational, prospective, multicentre, international study starting in March 2021. Participant recruitment has commenced. Basic demographic data, risk factors and vascular mapping parameters are collected via an online platform. The outcome measures are class of AVAS, predicted arteriovenous access, final arteriovenous access that has been created and a functionality of the arteriovenous access. Predictive models will be used for statistical analysis. Current status: A total of 140 patients from 4 centres in Great Britain, Czech Republic, Brazil and Slovakia are already included and undergoing evaluation. Conclusions: The study is registered in the Clinical trials registry (NCT04796558), https://register.clinicaltrials.gov/ . Study is still open for collaboration with other centres that can register via www.vavasc.com .

The Role of Free Tissue Transfers for Defect Coverage over the Body in Geriatric Populations

The treatment of soft tissue defects in multimorbid frail patients requires optimized preoperative and perioperative management with a differentiated interdisciplinary approach. Preoperative assessment with established scores, such as the ASA score, is important in order to stratify the operative complication risk. Following the reconstructive ladder is important to avoid unnecessary long operations and consecutively higher operative risks. In cases where a free flap procedure is needed, infections should be treated properly, and vascular status and coagulation should be optimized before performing a free flap procedure. Attention should be paid to maintain independency, functionality and quality of life while choosing the best treatment option.

Retinal Vascular Changes during the Menstrual Cycle Detected with Optical Coherence Tomography Angiography

Purpose. To evaluate the effects of the menstrual cycle on the retinal vascular status of healthy women by optical coherence tomography angiography (OCTA). Materials and Methods. Healthy women with regular natural menstrual cycles of 28 to 30 days were recruited for this prospective study. The women’s retinal vascular status was measured by OCTA at 3 time points: the early follicular, ovulatory, and midluteal phases of the menstrual cycle. The main outcome measures were foveal avascular zone (FAZ) parameters, perfusion density (PD) percentage in the superficial retinal capillary plexus (SCP), and PD percentage in the deep retinal capillary plexus (DCP). The mean arterial pressure (MAP), spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and axial (AL) were also measured in a same menstrual cycle. Results. In total, 62 right eyes of 62 women were included in the study. The mean age was 27.0 ± 1.73 (range, 24 to 31) years, and the mean menstrual cycle was 28.90 ± 0.84 (range, 28 to 30) days. The mean values of the DCP-PD parameters were significantly decreased in the nasal and inferior ETDRS subfields during the ovulatory phase. The mean DCP-PD in the nasal ETDRS subfield in the early follicular, ovulatory, and luteal phases was 54.11 ± 2.85, 56.39 ± 3.03, and 55.70 ± 3.27, respectively. The mean DCP-PD in the inferior ETDRS subfield in the early follicular, ovulatory, and midluteal phases was 52.90 ± 3.30, 54.86 ± 2.51, and 55.21 ± 2.64, respectively. No significant differences were found in MAP, SE, AL, IOP, FAZ area, or other quadrants of PD parameters, and no significant correlation was found between parameters by OCTA and age, MAP,SE, axial length, or IOP. Conclusions. The DCP-PD decreased in the nasal and inferior ETDRS subfields during the ovulatory phase in our study. This may indicate the need to consider the menstrual phase when interpreting DCP-PD parameters by OCTA in healthy women.

Correction of psychoemotional and vascular-autonomic dysfunction with patients suffering from endometrial disease under the influence of complex radon, laser, and drug treatment

The research objective is to develop a program to correct psycho-emotional and vascular-autonomic dysfunction with patients suffering from adenomyosis using complex radon, laser and drug treatment. Material and methods. There were 100 women with adenomyosis complicated by psycho-emotional and vascular-autonomic dysfunction from the age of 23 up to 37 years old who underwent treatment at a branch of Pyatigorsk Clinic of North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency of Russia. The patients were divided into 2 groups by a randomized method: the main group received radon, laser and drug therapy with Melaxen, the group of comparison received radon and laser therapy. Results. A comparative analysis showed the expediency of including adaptogens in the complex of sanatorium-and-spa treatment of patients with endometrial disease: the improvement of clinical symptoms in the main group compared to the group of comparison was more frequent by 1.36 times; normalization of vegetative management in the main group occurred with 72% of the patients compared to 52% in the group of comparison; in the main group the decrease in the intensity of anxious disorders was 2.64 times (p 0.01), against 1.46 times in the group of comparison (p 0.05); normalization of concentration of peptide and steroid hormones in blood serum in the main group was with 64% of the patients versus 42% in the group of comparison. Conclusion. Inclusion of Melaxen in the complex of traditional sanatorium-and-spa treatment of patients with adenomyosis (radon and laser therapy) provides significant improvement of neuroendocrine system, psycho-emotional, vegetative-vascular status.