Social Determinants of Health and Vascular Diseases: A Systematic Review and Call for Action

Several factors that underlie health inequality have been studied and defined as the social determinants of health (SDHs). The main SDHs are gender, socioeconomic status (SES), and ethnicity. In this study, disparity was analyzed in the context of vascular diseases (VDs) such as Peripheral Artery Disease (PAD), Chronic Venous Disease (CVD), Abdominal Arterial Aneurysm (AAA), and Carotid Stenosis (CS). This article aims to provide a comprehensive overview of the published evidence of the SDHs in VDs. For this purpose, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Published articles using the Scopus and ScienceDirect databases were searched. The criteria for the articles’ inclusion/exclusion were decided using a modified PICOTS framework. For the selected articles, the data sheets were organized in such a way to extract all data of potential relevance. Our findings showed that in VDs, gender, SES, and ethnicity are very important, with some specific problems for VDs analyzed. In conclusion, having detected the presence of SDHs that act negatively on VDs, a model based on action items for the SDHs associated with VDs was proposed

Metalloproteinases between History, Health, Disease, and the Complex Dimension of Social Determinants of Health

Metalloproteinases (MPs) belong to the superfamily of zinc endopeptidases, which are called metzincins. Three families of MPs have been studied in healthy and diseased conditions in humans. The first study on MPs was published in 1962, and following that, several studies characterized their activity and their effect on health and disease. Several diseases have been related to MPs, such as cardiovascular disease, cancer, inflammatory diseases, gynecological disorders, and others. Moreover, tissue inhibitors of metalloproteinases (TIMPs) have been widely studied, and drugs and artificial molecules that could target MP activity have been evaluated. MPs are relevant to public health because of their role in several diseases and, most of all, their role as biomarkers that also impact the quality of life and the psychosocial dimension of affected patients. In this context, new pathways to precision health and precision medicine have been opened in the area of MPs. This review describes, from the initial studies, the complex dimensions of MPs and related issues centered on health and disease dimensions

Endovenous radiofrequency ablation of tributary veins reflux

BACKGROUND: Varicose veins can be treated, after the evaluation of the reflux characteristics, with open or endovascular approaches. Radiofrequency ablation (RFA) has been recently proposed for the treatment of axial reflux (saphenous veins) but has never been evaluated its role in the treatment of tributary varices. Aim of this study was to evaluate the efficacy of RFA in the ablation of tributary veins reflux. METHODS: We performed a two years multicenter open-label study between 1st May 2014 and 30th April 2016. A precise preoperative anatomical and hemodynamic mapping by Duplex ultrasound examination was performed. Patients with tributary varicose veins were included to receive radiofrequency procedures. The varicose tributary vein must have a diameter within the range 2-20 mm with a minimum length of the segment to be treated of 7 cm. RESULTS: Two hundred seventy-four patients with tributary varicose veins were treated. Two-hundred and one (73.36%) were females and 73 (26.64%) were males; mean age was 53±17. As for the Clinical Class (C) of the CEAP classification, 109 (39.78%) patients belonged to C2, 96 (35.04%) patients belonged to C3, 40 (14.60%) patients belonged to C4, 11 (4.01%) patients belonged to C5, and 18 (6.57%) belonged to C6 patients. The preoperative venous diameter showed a mean of 8±3 mm. At one year follow-up the vein diameter mean value was of 4.1±0.7 mm (P<0.0001). Duplex ultrasound showed a venous occlusion rate of 100% at 1 year. No thrombotic complications were observed. Signs and symptoms improved in all patients. No recurrence was recorded within the time frame of the follow-up period. CONCLUSIONS: RFA of tributary varicosities seems to improve patients signs and symptoms with good cosmetic results and without particular complications

Clinical and Pathological Correlations in Chronic Venous Disease

Background Chronic Venous Disease (CVD) has a high prevalence in the western world. Varicose veins (VVs) are the main signs of this disease that is characterized by important pathological vessel wall changes. The aim of this study is to correlate the main histopathological abnormalities with related clinical issues of CVD. Methods A cohort of patients with VVs scheduled for open surgical treatment namely stab avulsion of VVs was recruited. Subsequently, venous tissue from stab avulsion was collected in order to evaluate the following biomarkers: Vascular-Endothelial Growth Factor (VEGF), Protein Gene Product 9.5 (PGP 9.5), Fibronectin (FN) and Matrix Metalloproteinase-9 (MMP-9). The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) criteria were used to classify CVD. Results Fourteen tissue fragments were processed for histological and immunohistochemical studies. Of these, 43 % were from CEAP C2 patients, 36 % from CEAP C3 patients and 21 % from CEAP C4 patients. CEAP Class C2 had few to moderate structures positive to VEGF; occasional structures positive to Fibronectin, numerous structures positive to MMP9, few to moderate structures positive to PGP 9.5. CEAP Class C3 had moderate structures positive to VEGF; few to moderate structures positive to Fibronectin; many structures positive to MMP9; few to moderate structures positive to PGP 9.5. CEAP Class C4 had numerous structures positive to VEGF; numerous structures positive to Fibronectin; abundant structures positive to MMP-9; few structures positive to PGP 9.5. Conclusions In this study, positive VEGF, FN, and MMP-9 structures were found with increasing trends in relation to the disease staging. VEGF and FN are associated with a progressive increase from C2 to C4. The MMP-9 marker has an important positivity even at early stage of the disease, being higher in CEAP C4 patients. PGP 9.5 decreases in CEAP C4 patients and this is concordant to decreased vein wall innervation