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This statement was endorsed by the American College of Radiology (ACR), American Podiatric Medical Association (APMA), Society of Interventional Radiology (SIR), Society for Vascular Medicine (SVM), Society for Vascular Surgery (SVS), Society for Clinical Vascular Surgery (SCVS), and Vascular & Endovascular Surgery Society (VESS) in September 2021. [ABSTRACT FROM AUTHOR]

Possible strategies to combat disparities in CLTI care.CLTI, chronic limb-threatening ischemia; PAD, peripheral artery disease. Amputation, disparities, peripheral artery disease (PAD), critical limb-threatening ischemia (CLTI) Keywords: amputation; critical limb-threatening ischemia (CLTI); disparities; peripheral artery disease (PAD) EN amputation critical limb-threatening ischemia (CLTI) disparities peripheral artery disease (PAD) 123 125 3 04/12/21 20210401 NES 210401 Peripheral artery disease (PAD) affects more than 8-10 million Americans and 200 million worldwide.[1] PAD has a dramatic impact on quality of life and greatly increases the risk of cardiovascular mortality. [Extracted from the article]

Superior vena cava syndrome has typically been associated with malignant conditions; however, the number of benign cases has started to grow as the use of upper-extremity venous lines and implantable cardiac devices increases. Whereas endovascular techniques are standardly used to treat patients with malignancies, the optimal care of patients with benign causes is less clear because they typically have longer life expectancies. We describe 2 cases of benign superior vena cava syndrome successfully managed with endovascular stenting, and we review the relevant literature. Of 145 cases in 10 series (average follow-up time, 24 mo), 96% of patients experienced symptomatic relief after endovascular management, with a primary patency rate of 66% and a secondary rate of 93%. Although few data exist to compare open surgical and endovascular techniques directly, both approaches appear to produce similar rates of patency. Both approaches frequently necessitate secondary intervention to maintain patency, but endovascular management is associated with fewer complications. We conclude that endovascular management of benign superior vena cava syndrome is a safe, effective, and reasonable initial management approach. [ABSTRACT FROM AUTHOR]

Background Venous thromboembolism contributes significantly to morbidity and mortality in cancer patients. Because cancer patients frequently have contraindications to anticoagulation, inferior vena cava filters are commonly placed. The use, safety, and retrieval of retrievable inferior vena cava filters in cancer patients have not been well studied. Methods A retrospective review of retrievable inferior vena cava filter use at a tertiary referral hospital was conducted between January 1, 2009 and December 31, 2011. Indications for inferior vena cava filter placement, anticoagulation practices, complications, filter retrieval, and patient outcomes were analyzed for patients with and without active cancer and for cancer subtypes, including localized and metastatic cases. Results Of 666 patients receiving retrievable inferior vena cava filters during this time period, 247 (37.1%) had active cancer. Of these, 151 (22.7%) had carcinoma, 92 (13.8%) had sarcoma, and 115 (17.3%) had metastatic disease. Overall, follow-up was available for a median of 401.0 (interquartile range: 107.5-786.5) days. Indwelling filter-related complications occurred in 19.8% of patients without cancer and 17.7% with an active cancer ( P = .50). Patients with cancer were less likely to have the filter retrieved (28.0% vs 42.0%, P < .001). In multivariable analysis, cancer was not associated with filter-related complications but was associated with a lower rate of filter retrieval. Conclusions In a modern cohort of patients undergoing retrievable inferior vena cava filter placement, active diagnosis of cancer is not associated with a significant increase in filter-related complications, but is associated with a reduced rate of filter retrieval. [ABSTRACT FROM AUTHOR]

This article describes a case study of a 73-year-old patient with a history of stroke who developed ventricular fibrillation followed by cardiogenic shock as a result of a critically narrowed left main coronary artery and an acutely occluded right coronary artery. It discusses revascularization in cardiogenic shock, ventricular support and cardiogenic shock and the current percutaneous coronary stroke intervention (PCI) in the era of public reporting.

Objectives: We developed and internally validated a risk score to predict in-hospital stroke or death after carotid artery stenting (CAS). Background: A tool that accurately assesses CAS risk could aid clinical decision making and improve patient selection. Methods: Patients undergoing CAS without acute evolving stroke from April 2005 through June 2011 as part of the NCDR Carotid Artery Revascularization and Endarterectomy (CARE) Registry were included. In-hospital stroke or death was modeled using logistic regression with 35 candidate variables. Internal validation was achieved with bootstrapping, and model discrimination and calibration were assessed. Results: A total of 271 (2.4%) primary endpoint events occurred during 11,122 procedures. Independent predictors of stroke or death included impending major surgery, previous stroke, age, symptomatic lesion, atrial fibrillation, and absence of previous ipsilateral carotid endarterectomy. The model was well calibrated with moderate discriminatory ability (C-statistic: 0.71) overall, and within symptomatic (C-statistic: 0.68) and asymptomatic (C-statistic: 0.72) subgroups. The inclusion of available angiographic variables did not improve model performance (C-statistic: 0.72, integrated discrimination improvement 0.001; p = 0.21). The NCDR CAS score was developed to support prospective risk quantification. Conclusions: The NCDR CAS score, comprising 6 clinical variables, predicts in-hospital S/D after CAS. This tool may be useful to assist clinicians in evaluating optimal management, share more accurate pre-procedural risks with patients, and improve patient selection for CAS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Autopsy studies consistently demonstrate cardiac involvement in thrombotic thrombocytopenic purpura (TTP), but clinical evidence for cardiac abnormalities is rarely reported. STUDY DESIGN AND METHODS: This systematic review addresses the apparent discrepancy between autopsy and clinical data. English language articles were identified by keywords for both TTP and for cardiac symptoms, testing, or events. Patients were analyzed if they were more than 10 years old with idiopathic TTP. RESULTS: Thirty articles were identified that described 111 eligible patients: 20 case reports described 27 patients, 9 retrospective cohort studies described 74 patients, and 1 prospective cohort study described 10 patients. Cardiac events included infarction (26 patients), congestive failure (17), arrhythmias (10), cardiogenic shock (6), and sudden cardiac death (8). Mortality was assessed in 101 patients: 55 died, and 48 autopsies were described. All demonstrated cardiac microvascular thrombi, hemorrhage, and/or necrosis. Follow-up information was reported in only 6 of the 16 patients who survived a cardiac event (follow-up duration, 10 days-2 years; median, 7 weeks). CONCLUSIONS: The frequency and sequelae of clinical cardiac abnormalities in TTP cannot be accurately assessed because most patients were described in reports of few selected patients; many patients were reported before the availability of effective treatment for TTP and sensitive tests for cardiac involvement. Continuing case reports and cohort studies, however, suggest that cardiac abnormalities may be important and often unrecognized causes of mortality and morbidity in patients with TTP. Prospective studies are needed to determine if cardiac therapy can improve survival and long-term outcomes of patients with TTP. [ABSTRACT FROM AUTHOR]

The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed. [ABSTRACT FROM AUTHOR]

Recent studies have highlighted differences in how older patients respond to high-risk pulmonary embolism (PE) and treatment. However, guidelines for PE risk stratification and treatment are not based on age, and data are lacking for older patients. We characterized the impact of age on clinical features, risk stratification, treatment, and outcomes in a sample of patients with PE in the emergency department. We performed an observational cohort study of 547 consecutive patients with PE in the emergency department from 2005 to 2011 in an urban tertiary hospital. We used bivariate proportions and multivariable logistic regression to compare clinical presentation, risk category, treatment, and outcomes in patients =65 years with those <65 years. The mean age was 58 ± 17 years, 276 (50%) were women, and 210 (38%) were =65 years. PE was more severe in patients =65 years (massive 14% vs 5%, submassive 48% vs 25%, and low risk 38% vs 70%, p <0.0001), with submassive PE being the most common presentation in patients =65 years. However, subanalysis removing natriuretic peptides from the definition of submassive PE negated this finding. Treatment with parenteral anticoagulation (88% vs 90%, p = 0.32), thrombolytic therapy (5% vs 4%, p = 0.87), and inferior vena cava filter (4% vs 4%, p = 0.73) were similar among age groups. Patients =65 years had higher 30-day mortality (11% vs 3%, p <0.001). In conclusion, patients =65 years present with more severe PE and have higher mortality, although treatment patterns were similar to younger patients. Age-specific guideline definitions of submassive PE may better identify high-risk patients. [ABSTRACT FROM AUTHOR]

Retrievable inferior vena cava filters (IVCFs) were designed to provide temporary protection from pulmonary embolism in high-risk situations. However, little is known about their effectiveness, and many remain permanently implanted, leading to potential complications. The aim of this study was to determine patient characteristics, indications for IVCF placement, retrieval rates, complications, and post-IVCF anticoagulation (AC) practices in patients who have received IVCFs. A retrospective review of IVCF use by 3 specialty groups from January 1, 2009, to December 31, 2011, was conducted at a tertiary referral center. Indications for IVCF, procedural success and complications, post-IVCF AC practices, and patient outcomes were assessed. Seven hundred fifty-eight IVCFs were placed. Follow-up was available for 688 patients (90.7%) at a median of 342.0 days (interquartile range 81.5 to 758.0). Indications for IVCF placement included contraindication to AC in the presence of acute venous thromboembolism (n [ 287 [41.7%]) and prophylaxis (n [ 235 [34.2%]). Insertion-related complications occurred in 28 patients (4.1%). After IVCF placement, adequate AC was initiated in 454 patients (66.0%) <3.0 days (interquartile range 0 to 13.0) after insertion, but the overall retrieval rate was only 252 of 688 (36.6%) within a median of 134.0 days (interquartile range 72.50 to 205.8). Significant IVCF-related complications occurred in 122 patients (17.7%) within 32 days (interquartile range 13.0 to 116.8). The most common complication (72 of 131 [55.0%]) was deep vein thrombosis. In conclusion, in a large, modern cohort of patients receiving retrievable IVCFs for a variety of indications by various specialties, IVCF insertion remains safe. However, many patients have IVCF-related complications, and often, even when IVCFs are retrieved, there is a delay between AC and retrieval. Quality improvement initiatives that facilitate the expeditious retrieval of IVCF are needed. [ABSTRACT FROM AUTHOR]

Focuses on the alteration of the mammalian cardiovascular structure in the transition to pulmonary respiration following birth. Remodeling of the ductus arteriosus; Regulation of the closure of the cardiovascular system by prostaglandins; Prevention of the premature closure of the ductus arteriosus.

The article presents a case study of a thirty-year-old lady postprandial abdominal pain who had a history of hysterectomy, ulcerative colitis and bilateral oophorectomy. She underwent an angiography which revealed compressions in the superior mesenteric artery (SMA). She was diagnosed with dynamic mesenteric vascular compression syndrome. The article discusses atherosclerosis causing mesenteric ischemia and median arcuate ligament syndrome (MALS) due to compressions in the celiac artery (CA).