International angiology: a journal of the International Union of Angiology (Int Angiol)

Publications in this journal

• Article: Hyperhomocysteinemia as a consequence of life style among patients suffering from Thromboangiitis Obliterans

  Bahare Fazeli
  International angiology: a journal of the International Union of Angiology 02/2013;
• Article: guidelines for Venous thromboembolism in Asia

  liew NC
  International angiology: a journal of the International Union of Angiology 01/2012;
• Article: Lymphatic malformations

  Mattassi R
  International angiology: a journal of the International Union of Angiology 01/2011;
• Article: Surgical treatment of a patient with progressive thrombosis of the renal artery associated with neurofibromatosis.

  H Kimura, O Sato, J-O Deguchi, T Miyata
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  ABSTRACT: Pediatric renovascular hypertension (RVH) associated with neurofibromatosis 1 (NF1) is a rare entity that is often resistant to endovascular treatment. A 12-year-old girl with NF1 and hypertension presented with severe stenosis of the right main renal artery and its posterior segment, the latter of which thrombosed spontaneously, and total occlusion of the celiac artery with rare branching of the accessory middle colic artery. She underwent successful reconstruction of the anterior segment of the right renal artery, and has been free of medication for ten years. A review of the recent literature suggests that renal artery bypass remains the best treatment in pediatric RVH with NF1.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):503-6.
• Article: Periodontitis and abdominal aortic aneurysms: a random association or a pathogenetic link?

  K I Paraskevas, D P Mikhailidis, A D Giannoukas
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  ABSTRACT: A number of micro-organisms have been implicated in the development/progression of abdominal aortic aneurysms (AAAs), thus suggesting an infective theory of AAA pathogenesis. Periodontitis may be involved in the development of AAAs by means of introduction of subgingival plaque periodontal bacteria into the bloodstream and degeneration of the aortic wall. A different theory supports that the findings of periodontal pathogens in AAA biopsies are a secondary phenomenon with transient bacteremia leading to invasion of already formed AAAs. It is not yet clear whether the periodontopathic bacteria accelerate the growth/weakening of the aortic wall or whether they are secondary colonizers of AAAs. Clarification of the association between periodontal disease and AAAs in large-scale studies holds implications for a role for chemoprophylaxis/antibiotic treatment in the management of AAAs.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):431-3.
• Article: Thyroid hormone modulates the responsiveness of rat aorta to alpha1-adrenergic stimulation: an effect due to increased activation of beta2-adrenergic signaling.

  M Pappas, K Mourouzis, H Karageorgiou, C Tesseromatis, I Mourouzis, G Kostopanagiotou, C Pantos, D V Cokkinos
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  ABSTRACT: The ability of the thyroid hormone to increase cardiac output and to lower systemic vascular resistance may provide a novel treatment for cardiovascular diseases. Therefore, understanding the mechanisms of thyroid hormone action on the heart and peripheral vasculature could be of clinical importance. We previously found that thyroid hormone modulates the alpha1-adrenergic effect on vascular reactivity of rat aortas. In the present study we further investigated possible mechanisms of this response. Hyperthyroidism was induced on Wistar-Kyoto male rats with L-Thyroxine, (THYR) treatment for two weeks, N.=18 while untreated rats used as controls (NORM), N.=16. The thoracic aorta was dissected and cut into rings that were suspended in an isolated organ bath with Krebs-Henseleit buffer. Maximal tension, Tmax, in g was measured in response to Potassium Chloride (KCl) and Phenylephrine (PE) in rings in the presence of Ritodrine, a beta-2 agonist (NORM-RITO, N:=8, THYR-RITO, N.=9), or in the absence of Ritodrine (THYR, N.=9, NORM, N.=8). With KCL, Tmax was not different between the THYR, NORM, NORM-RITO, and THYR-RITO groups. With PE, there was a difference in Tmax between NORM-RITO and NORM, 0.66 (0.056) g vs 1.00 (0.066) g, P<0.05 and THYR and NORM, 0.75 (0.055) g vs 1.00 (0.066) g, P<0.05. No significant difference was observed between THYR-RITO AND THYR. Furthermore, Relax % was not significantly different between the NORM and the THYR, NORM-RITO, and THYR-RITO groups, 64.5%(3.7) vs 67.3%(6.7), 73.5% (4.3) and 81.8 %(4.7), P>0.05. PE induced vasoconstriction in isolated rat aortic rings was reduced after both ritodrine and thyroxine treatment. However, co-administration of thyroid hormone and ritodrine did not result in a synergistic reduction of PE induced vasoconstriction. Thus, thyroxine may modulate the alpha1-adrenergic vascular responsiveness by enhancing beta2-adrenergic stimulation.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):474-8.
• Article: Transcutaneous oxygen pressure measurements in diabetic and non-diabetic patients clinically suspected of severe limb ischemia: a matched paired retrospective analysis.

  E Biotteau, G Mahe, P Rousseau, G Leftheriotis, P Abraham
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  ABSTRACT: It was recently suggested that a 6 mmHg difference exists in both chest and foot transcutaneous oxygen pressure (TcPo2) between diabetic and non-diabetic volunteers apparently free from vascular disease. If a difference can also be found in diabetic and non-diabetic patients with clinically suspected critical limb ischemia (CLI), this may question the use of the same 30 mmHg threshold proposed by the "TASC" in the definition of CLI. We analyse whether a difference can be found for chest and foot TcPo2 respectively between diabetic and non-diabetic patients referred for clinically suspected CLI. A retrospective matched paired study was performed among 60 diabetic and 60 non-diabetic subjects with peripheral artery disease and suspected critical limb ischemia. Results are presented as median [25-75 centiles]. Groups were comparable in terms of gender, age, height, systolic blood pressure and treatments (except for renin-angiotensin inhibitors). Chest-TcPo2 was 53 [43-57] mmHg in diabetic and 60[49-65] mmHg in non-diabetic patients (P<0.01). Foot-TcPo2 was 12[3-34] mmHg in diabetic and 15[3-36] mmHg in non-diabetic patients (Non significant). A multi-parametric step by step regression analysis showed that chest-TcPo2 was inversely associated with weight, then with diabetes and gender. TcPo2 is lower at the chest but not at the foot level in diabetic than in non-diabetic patients with suspected CLI. Then, the "30 mmHg threshold" proposed in the definition of lower-limb CLI is likely applicable in both diabetic and non-diabetic patients.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):479-83.
• Article: The risk of congestive heart failure is increased in persons with varicose veins.

  L A Mäkivaara, T M Ahti, T Luukkaala, M Hakama, J O Laurikka
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  ABSTRACT: Varicose veins are a common condition but their etiology and relationship with other cardiovascular diseases are not well established. The aim of the study was to find out if persons with varicose veins have a higher risk of congestive heart failure (CHF) than persons without varicose veins. The prevalence of CHF at entry and the incidence of CHF during a five-year follow-up period were studied in persons with and without varicose veins. A study was conducted with a questionnaire in a population of 4903 middle-aged residents in Tampere, Finland. Marginally higher prevalence of CHF was found in persons with varicose veins than in those without (2.9% vs. 1.9%) with OR 1.6 (1.0-2.3) and sex and age adjusted OR 1.2 (0.8-1.9). The incidence of CHF was higher in subjects with varicose veins than in others (4.9 vs. 2.6 per 1000 person-years) with IDR 1.9 (1.1-2.9) and sex and age adjusted IOR 2.5 (1.4-4.6). The result was further adjusted for body mass index, arterial disease and hypertension; multi-adjusted IOR for the incidence of CHF by varicose veins was 2.1 (1.1-4.0). Our longitudinal observation is consistent with the hypothesis that persons with varicose veins have a higher risk of CHF which is not mediated through sex, age, overweight, arterial disease or hypertension.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):452-7.
• Article: Peroneal nerve injury during varicose veins surgery.

  J Herman, Z Sekanina, P Utikal, P Bachleda, M Duda
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  ABSTRACT: The aim of the presented work was to assess the causes of injury to great nerves during varicose vein surgery and comment on the consequences. This was a retrospective study of 2344 patients operated on for primary varicose veins between the years 1980 and 2005. In three patients out of 2344 the peroneal nerve was injured. The three patients underwent neurosurgery. In the first patient transplantation of the sacral nerve was performed. In the second patient the nerve was released from ligatures, and in the third patient the nerve was first released from the cicatrice and the transposition of the tendon of the posterior tibial muscle followed. All three patients went through intensive rehabilitation. The first patient still wears peroneal splint, the limb is atrophic. In the second patient the function has been well restored and he is not disabled anymore. However, the restitution of the lower limb function is not sufficient for him to work as a teacher of physical education. The third patient still suffers from serious paresis of the peroneal nerve. Even a frequent and relatively simple intervention such as varicose vein surgery may be accompanied by serious complications affecting patients for the rest of their lives. Serious motor nerve injuries are encountered only in operations in the popliteal fossa and the fibula head. Complications are more frequent when operations are performed by young general surgeons than when they are performed by an experienced surgeon or an expert in vascular surgery. The affected patients should be referred for neurosurgery; however, results are unpredictable. In spite of an intensive rehabilitation and possible plastic surgery the patients are permanently affected.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):458-60.
• Article: Impact of the metabolic syndrome and its components combinations on arterial stiffness in Type 2 diabetic men.

  D Levisianou, A Melidonis, E Adamopoulou, E Skopelitis, A Koutsovasilis, I Protopsaltis, M Zairis, S Kougialis, I Skoularigis, G Koukoulis, S Foussas, F Triposkiadis
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  ABSTRACT: Arterial stiffness (AS) is a risk marker of atherosclerosis and coronary artery disease, yet its association with metabolic syndrome (MS) in diabetic patients is not established. The aim of this study was to investigate possible association of MS or its components with AS in diabetic population and to identify the MS definition which better correlates with AS. Overall, 98 type-2 diabetic men, mean age 64+/-10 years, were classified into groups according to the presence of MS, using the National Cholesterol Educational Program-Adult Treatment Panel III (NCEP-ATPIII) and International Diabetes Federation (IDF) definition. AS was estimated using carotid-femoral pulse wave velocity (PWV). For between-group comparisons and correlations between MS and it's components with AS, t-test and Pearson's correlation coefficient were employed, respectively. For multivariable analysis a linear regression model was used. PWV in those with (72.5%) and without NCEP-ATPIII MS was 13.4+/-2.9 vs 12+/-3.2 m/s (P=NS) and in those with (79.6%) and without IDF MS 13.6+/-2.8 vs 11+/-3.2 m/s (P=0.036). AS positively correlated with IDF MS (r=0.332, P=0.036), increased blood pressure (r=0.324, P=0.037), and the combination of increased waist circumference according to IDF with hypertension (r=0.380, P=0.013); no correlation with NCEP-ATPIII MS was detected. In multivariable analysis, age, hypertension, and IDF MS were independently associated with AS (beta=2.52, P=0.039). IDF MS is independently associated with increased AS in diabetic men. Additionally, abdominal obesity, hypertension and older age were likely to be associated with increased AS. PWV measurement may be indicated in such patients.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):490-5.
• Article: Clinical and biochemical parameters related to cardiovascular disease after Helicobacter pylori eradication.

  R Pellicano, E Oliaro, S Fagoonee, M Astegiano, M Berrutti, G Saracco, A Smedile, A Repici, N Leone, A Castelli, C Luigiano, M Fadda, M Rizzetto
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  ABSTRACT: Since the major established risk factors explain the pathogenesis of ischemic heart disease (IHD) in a proportion of cases, it is crucial to search for other causal mechanisms. The possible link between IHD and Helicobacter pylori (H.pylori) infection has been reported. However, the precise mechanism of this potential relationship, by a proinflammatory activity or metabolic disorder, is unclear. In order to investigate this issue, the authors assessed changes in clinical and biochemical parameters related to IHD after bacterial eradication. A total of 496 patients (281 males; mean age 59.7+/-2.3) with H.pylori-positive dyspepsia and/or peptic ulcer were studied after cure of the bacterium. H.pylori status was determined by histology or 13C-urea breath testing. Examinations for body mass index, diastolic blood pressure and blood testing (C-reactive protein, fibrinogen, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, fasting glucose) were performed before eradication and annually for up to five years thereafter. For statistical analyses, the Student's t test was performed. HDL-C increased (P=0.02) while C-reactive protein and fibrinogen levels diminished (P<0.0001) significantly. BMI and diastolic blood pressure increased in a significant (P=0.032 and P=0.039 respectively) manner compared to baseline. H.pylori eradication is associated with modification of some clinical and biochemical parameters related to IHD during a follow-up of five years. There is a need for large interventional randomized studies in order to prove a causal association.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):469-73.
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  Article: Carotid endarterectomy: general anaesthesia with remifentanyl conscious sedation vs loco-regional anaesthesia.

  G Marcucci, A Siani, R Antonelli, F Mounayergi, F Accrocca, G A Giordano, R Gabrielli, G Pierettori, A Sbroscia
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  ABSTRACT: To retrospectively evaluate and compare the safety and efficacy of general anesthesia with remifentanyl conscious sedation (RCS) vs local-regional anesthesia (LA) for carotid endarterectomy (CEA). From January 2004 to January 2008, 390 CEA performed in 325 patients (M/F 214/111, age 75 +/- 7) were collected in 2 groups: RCS group included 275 consecutive CEA in 230 patients carried out under remifentanyl conscious sedation with stopping of the remifentanyl infusion at the carotid clamping time to evaluate the clinical neurological status; LA group was composed of 115 consecutive CEA in 95 patients, performed under local-regional anesthesia. We evaluated complications, postoperative morbidity and mortality, need for shunt insertion and compared the results by means of Student's t-test and chi2 analysis. P value <0.05 (T=2.28) was considered significant. The 30 days mortality was 0.35% in the RCS group and 0% for LA group (P=NS). The 30 days stroke rates were 0.3% and 0% respectively (P=NS). TIA/RIND rates were 0.3% for RCS group and 1.7% for LA group (P=0.47); shunt usage was 20% for RCS group and 17% for LA group (P=0.26). We found higher postoperative nausea/vomiting in the RCS group (3.9% vs 0.8%, P<0.05). General anesthesia with remifentanyl conscious sedation seems to be a safe technique, allowing monitoring of the neurological status, cerebral protection during arterial clamping, better control of the airway and a good compliance to both the surgeon and the patient. A randomized control trial is needed to prove RCS to be effective as LA.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):496-9.
• Article: Stent placement in the superficial femoral artery for patients on chronic hemodialysis with peripheral artery disease.

  T Nishibe, Y Kondo, A Dardik, A Muto, J Koizumi, M Nishibe
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  ABSTRACT: Chronic hemodialysis is associated with a high prevalence of peripheral artery disease (PAD), and patients on chronic hemodialysis with PAD have an increased risk of critical limb ischemia. The present study assessed the hemodynamic and clinical outcomes of stent placement in the superficial femoral artery (SFA) for patients on chronic hemodialysis. Between February 2005 to August 2008, 43 consecutive lower limbs in 42 patients with SFA lesions that were successfully treated by primary stent placement were included in this study. Those were divided into a dialysis group (18 limbs) and a nondialysis group (25 limbs). Outcome measures included primary patency, assisted primary patency, limb salvage, and survival. Patients were significantly younger and presented with significantly more symptomatic limb ischemia in the dialysis group compared to the nondialysis group, despite comparable TransAtlantic Inter-Society Consensus (TASC) classification scores of SFA lesions between the two groups. The primary patency, primary assisted patency, limb salvage, and survival rates of the dialysis group were similar to those of the nondialysis group. Stent placement in the SFA is a feasible, safe, and effective procedure in patients on chronic hemodialysis with PAD, and may be offered as a first-choice therapeutic option for these patients.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):484-9.
• Article: Editorials: a rose is a rose.

  N Papanas, E Maltezos, M K Lazarides
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):429-30.
• Article: The importance of a standing position in the diagnosis of Nutcracker phenomenon by duplex sonography.

  A Romera-Villegas, R Vila-Coll, M Cairols-Castellote, R Poveda-Monge, C Masuet-Aumatell, M Grinyó-Boira
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  ABSTRACT: To determine the clinical usefulness of Doppler ultrasonography in the diagnosis of the Nutcracker phenomenon, as an alternative to computed tomographic scans (CT). This study consisted of 52 patients that presented with intermittent hematuria of unknown origin between January 2006 to April 2008. Doppler ultrasonography was used to assess the left renal vein (LRV) by measuring the anteroposterior (AP) diameter and peak systolic velocity (PSV) in supine and standing positions, at the hilar and interaortomesenteric portions of the LRV. These data were compared with CT scans. The sensitivity and specificity of duplex sonography was determined using the AP diameter and PSV ratios to assess the cut-off levels. Kappa (k) statistic was also evaluated. mean AP diameters of the LRV measured by Doppler sonography were 8.38 mm at the hilar and 3.17 mm under the SMA, compared to 9.3 mm (hilar) and 3.2 mm (SMA) in the supine and standing position respectively. The PSV in the supine position was 25.77 cm/s and 115.48 cm/s, respectively, compared to 25.54 cm/s and 125.96 cm/s in the standing position. The cut-off levels were 3.85 (sensitivity: 61.5%, specificity: 80.8%, k:0.42) for the supine and 4.12 (sensitivity:61.5%, specificity: 65.4%, k: 0.27) for the standing AP diameter, 2.99 (sensitivity: 92.3%, specificity: 73.1%, k: 0.65) for the supine and 3.73 (sensitivity: 96.4%, specificity: 79.2%, k: 0.76) for the standing PSV. Our data show that the standing PSV ratio is the best parameter for to detecting entrapment of the LRV.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):461-8.
• Article: Endovascular treatment of calcified plaque in the thoracic aorta after recurrent massive embolization.

  M Altreuther, A Ødegård, F Aasgaard, C A Lange, H O Myhre
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  ABSTRACT: A 65 year old female patient was admitted with acute onset of severe intermittent claudication in the right lower extremity. Angiography revealed embolic material in the right femoral artery and peripheral arterial thrombosis in the right leg. She was treated with thrombolysis first, thereafter calcified embolic material was removed by open embolectomy. A CT scan showed massive calcification in the thoracic aorta at the level of the occluded left subclavian artery, obviously the origin of embolization. On the second postoperative day she developed critical ischemia in the left lower limb. Angiography showed massive embolization in the left common and external iliac arteries. Following open embolectomy, stentgrafting of the descending thoracic aorta was performed. At one year the patient is in good condition.
  International angiology: a journal of the International Union of Angiology 12/2009; 28(6):500-2.
• Article: Amiodarone: pharmacological profile, animal-model experimental data and clinical use. How important is the vasodilating effect?

  A Hatzitolios, G Ntaios, C Savopoulos
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  ABSTRACT: Amiodarone, the major representative of class III antiarrhythmic agents, is widely used in the treatment of ventricular and hyperventricular arrhythmias, being specifically useful in the therapy of patients suffering from life threatening ventricular arrhythmias. The combination of antianginal and antiarrthythmic actions of amiodarone is an extremely significant advantage regarding the treatment of patients with chronic atherosclerotic cardiopathy, as heart rate disorders are frequently fatal in coronary heart disease and, reversely, a high percentage of cardiac arrhythmias are caused by coronary heart disease. Since 1980s, several experimental in vitro and in vivo data, as well as clinical studies, regarding both systematic and coronary circulation, support the vasodilative effects of amiodarone. We have previously showed that amiodarone in vitro exerts a vasodilator effect in isolated vessel tissue, mainly via the activation of intracellular calcium binding mechanisms, a fact that differentiates this agent from other coronary vasodilative drugs, such as calcium channel blockers, that affect extracellular calcium ions entrance. Thus, the vasodilative, antianginal and antiarrhythmic actions of amiodarone may be further enhanced by the simultaneous supplementation of calcium channel blockers via synergistic mechanisms, supporting the clinical use of such drug combinations. Finally, as amiodarone and noradrenaline have been reported to exert antagonistic actions, the application of amiodarone is particularly indicated in pathologic conditions characterized by the stimulation of sympathetic nervous system (sympathicotonia).
  International angiology: a journal of the International Union of Angiology 10/2009; 28(5):353-62.
• Article: Post-traumatic pseudoaneurysm of the great saphenous vein: a case report.

  Z Járányi, E Dósa, B Nemes, V Bérczi, K Hüttl
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  ABSTRACT: Venous (pseudo)aneurysms are rare entities. Herewith we report a case of the right lower extremity in a 42-year-old woman in whom a non-pulsatile mass was diagnosed only by physical examination as a hematoma and was treated conservatively. Six months later ultrasound and phlebography identified a pseudoaneurysm of the great saphenous vein. Post-traumatic venous pseudoaneurysm should be considered among the differential diagnostic options of a subcutaneous non-pulsatile mass in patients with a history of physical trauma. Surgery was offered which was rejected by the patient. Further one month follow-up showed no change.
  International angiology: a journal of the International Union of Angiology 10/2009; 28(5):425-7.