Ocena właściwości mechanicznych tętnic ludzkich poddanych procesowi wyjałowienia oraz kontrolowanego zamrażania przy wykorzystaniu krioprotektora

Background: Assessment of the mechanical properties of human arteries after cryopreservation processing protocol including antibiotic sterilisation and controlled freezing with the use of cryoprotector (10% DMSO). Material and methods: 12 aortic and 9 femoral artery segments were investigated; the donor age ranged from 18 to 42 years, the time of the storage in the liquid nitrogen vapours was from 1 to 36 months. The stretching tests of vessel specimens (using INSTRON tensile testing machine) and manometric investigations were performed. The mechanical resistance (breaking stress) and elastic moduli were evaluated (at maximal stress value and at the stress of 300 kPa). The results were compared with fresh homograft specimens. Results: The mechanical resistance (breaking stress) of the investigated cryopreserved aortic segments ranged from 1.5 MPa (± 0.34) (if stretched perpendicular to the vessel long axis) to 1.05 MPa (± 0.3) (if stretching was performed in parallel). For the femoral artery specimens the respective values were 2.4 MPa (± 0.93) and 1.35 MPa (± 0.5). Elastic moduli at the stress of 300 kPa in aortic specimens achieved 1.38 (± 0.4) and 1.8 (± 0.85). For the attained femoral arteries respective values were 2.83 (± 1.34) and 1.47 (± 0.9). There were no significant differences concerning mechanical properties between fresh and cryopreserved aortic wall segments. Conclusions: 1. Cryopreserved allogenic arteries (aorta, femoral arteries) maintain high mechanical resistance against breaking stress and intra-arterial pressure. 2. Despite vessel preparation (including sterilisation and control freezing protocols), cryopreserved arteries maintain elastic properties, justifying an implementation of this material in human circulatory system. 3. The use of arterial segments with low number of collaterals and their correct suture or ligation can influence the allograft mechanical stress resistance

Application of deep oscillation therapy in the treatment of peripheral arterial diseases

Intermittent claudication is a common symptom of peripheral arterial disease, affecting up to 50% of patients over the age of 50, which is characterized by pain, discomfort, and cramping in the leg muscles during physical activity. Intermittent claudication is a common symptom of lower extremity arterial disease (LEAD), which significantly impacts patients’ quality of life and drives healthcare costs. Current treatments for intermittent claudication are often inadequate, leading to a need for more effective treatments. Developing new treatments is critical to improve outcomes for patients and address the public health implications of LEAD. This study’s aim was to present the impact of comprehensive physiotherapy, conducted independently, with the supervision of a physiotherapist, for 14 weeks, on a patient with intermittent claudication caused by peripheral arterial disease. The therapy included bicycle training in a form of physical therapy at home, combined with deep oscillation therapy. Deep oscillation therapy involved the use of an electrostatic field with a frequency of 5 to 250 Hz. The field was applied following the lymphatic drainage methodology. In the discussed case, a statistically significant and favourable increase in the measured variables was observed, such as the increase of bone-brachial index from 0.65 to 0.8, the increase of tissue perfusion, measured by laser Doppler flowmetry, from 12.3% to 61%, depending on the measurement site, and the increase in pain-free walking distance by 451%. TcPO2 measurement in the affected leg increased from 31 to 48 mmHg. The use of physical therapy at home combined with deep oscillation showed improvements in pain-free walking distance, Ankle Brachial Index, and other measures in patients with peripheral arterial disease. Deep oscillation therapy demonstrated potential analgesic effects but also raised concerns about possible nerve damage. The study indicated that physical therapy at home might serve as an alternative to supervised exercise therapy, but it had limitations like a small sample size and lack of direct comparisons

Application of deep oscillation therapy in the treatment of peripheral arterial diseases

Intermittent claudication is a common symptom of peripheral arterial disease, affecting up to 50% of patients over the age of 50, which is characterized by pain, discomfort, and cramping in the leg muscles during physical activity. Intermittent claudication is a common symptom of lower extremity arterial disease (LEAD), which significantly impacts patients’ quality of life and drives healthcare costs. Current treatments for intermittent claudication are often inadequate, leading to a need for more effective treatments. Developing new treatments is critical to improve outcomes for patients and address the public health implications of LEAD. This study’s aim was to present the impact of comprehensive physiotherapy, conducted independently, with the supervision of a physiotherapist, for 14 weeks, on a patient with intermittent claudication caused by peripheral arterial disease. The therapy included bicycle training in a form of physical therapy at home, combined with deep oscillation therapy. Deep oscillation therapy involved the use of an electrostatic field with a frequency of 5 to 250 Hz. The field was applied following the lymphatic drainage methodology. In the discussed case, a statistically significant and favourable increase in the measured variables was observed, such as the increase of bone-brachial index from 0.65 to 0.8, the increase of tissue perfusion, measured by laser Doppler flowmetry, from 12.3% to 61%, depending on the measurement site, and the increase in pain-free walking distance by 451%. TcPO2 measurement in the affected leg increased from 31 to 48 mmHg. The use of physical therapy at home combined with deep oscillation showed improvements in pain-free walking distance, Ankle Brachial Index, and other measures in patients with peripheral arterial disease. Deep oscillation therapy demonstrated potential analgesic effects but also raised concerns about possible nerve damage. The study indicated that physical therapy at home might serve as an alternative to supervised exercise therapy, but it had limitations like a small sample size and lack of direct comparison

The Zilver® PTX® Single Arm Study: 12-month results from the TASC C/D lesion subgroup

AIM:The aim of the present article was to report the 12-month results of the Zilver® PTX® Single Arm StudyTASC C/D de novo lesion subgroup.METHODS:The Zilver PTX Drug-Eluting Peripheral Stent is a self-expanding nitinol stent with a polymer-free paclitaxel coating. This is a prospective, single-arm, multicentre clinical study evaluating the Zilver PTX Drug-Eluting Peripheral Stent for treating patients with symptomatic lesions in the above-the-knee femoropopliteal artery. This study enrolled 787 patients (900 lesions) with Rutherford class 2 or higher treated with the Zilver PTX stent; 135 were long de novo lesions, corresponding to TASC II Class C or D.RESULTS:The 135 long lesions had a mean length of 226.1±43.6 mm. The 12-month Kaplan-Meier estimates included a 77.6% primary patency rate, an 84.7% event-free survival rate, and an 85.4% rate of freedom from target lesion revascularization (TLR). The 12-month stent fracture rate was 2.1%.CONCLUSION:The primary patency rates in the analysis of the TASC C/D de novo lesion subgroup of the Zilver PTX Single Arm Study indicate that endovascular therapy outcomes with a paclitaxel eluting stent may equal those of bypass surgery. Endovascular treatment with DES may play an important role for treatment of patients who present with TASC C or D femoropopliteal lesions

Nitinol stents with polymer-free paclitaxel coating for lesions in the superficial femoral and popliteal arteries above the knee: twelve-month safety and effectiveness results from the Zilver PTX single-arm clinical study.

PURPOSE: To report a prospective, single-arm, multicenter clinical study evaluating the Zilver PTX drug-eluting stent for treating the above-the-knee femoropopliteal segment (NCT01094678; http://www.clinicaltrials.gov ). METHODS: The Zilver PTX drug-eluting stent is a self-expanding nitinol stent with a polymer-free paclitaxel coating. Patients with symptomatic (Rutherford category 2-6) de novo or restenotic lesions (including in-stent stenosis) of the above-the-knee femoropopliteal segment were eligible for enrollment. Between April 2006 and June 2008, 787 patients (578 men; mean age 66.6\ub19.5 years) were enrolled at 30 international sites. RESULTS: Nine hundred lesions (24.3% restenotic lesions of which 59.4% were in-stent stenoses) were treated with 1722 Zilver PTX stents; the mean lesion length was 99.5\ub182.1 mm. The 12-month Kaplan-Meier estimates included an 89.0% event-free survival rate, an 86.2% primary patency rate, and a 90.5% rate of freedom from target lesion revascularization. There were no paclitaxel-related adverse events reported. The 12-month stent fracture rate was 1.5%. The ankle-brachial index, Rutherford score, and walking distance/speed scores significantly improved (p<0.001) from baseline to 12 months. CONCLUSIONS: These results indicate that the Zilver PTX drug-eluting stent is safe for treatment of patients with de novo and restenotic lesions of the above-the-knee femoropopliteal segment. At 1 year, the overall anatomical and clinical effectiveness results suggest that this stent is a promising endovascular therapy

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC).

International audienc