Microcirculation disorders of the oral cavity in patients with primary Raynaud phenomenon

Raynaud phenomenon is a medical condition in which the spasm of the arteries causes episodes of reduced blood flow. Potential disorders in the microcirculation of the oral mucosa may promote the occurrence of lesions. The aim of the study was to investigate the association of the frequency of oral cavity lesions with oral microcirculatory dysfunction in patients with primary Raynaud phenomenon (PRP) in comparison with healthy control group. Measurements of oral capillary flow were performed using laser doppler flowmetry (LDF) in 61 patients with PRP. In a group of 31 of 61 patients (group 1), the measurements were made during a Raynaud phenomenon (RP) attack. The RP attack was caused by stress initiated by the examination or the first visit itself. The RP attack was not deliberately caused by a cold test, vibration40w56 or any stress test. After 10 to 14 days, the measurements were repeated in all 61 patients and in the control group, and a dental examination was performed. Follow‑up visits were conducted every 3 months for a period of 12 months to monitor oral mucosa. Differences in LDF were found between various anatomical points in both the PRP and control groups. On the first visit, the LDF flow in group 1 was significantly lower at all examined points in comparison with those in the control group. On the second visit, differences were observed in the LDF of the teeth and oral mucosa temperature in all patients with PRP in comparison with controls. Oral cavity lesions reported in the past and at follow‑up were significantly more common in patients with PRP. Patients with PRP have dysfunction in the microcirculation of the oral mucosa and they more often have lesions in the oral cavity

The relationship between pulse waveform analysis indices, endothelial function and clinical outcomes in patients with peripheral artery disease treated using percutaneous transluminal angioplasty during a one-year follow-up period

Background: Several predictors of clinical outcomes after percutaneous transluminal angioplasty (PTA) interventions in patients with peripheral arterial disease (PAD) have been investigated. Indices of endothelial function, arterial pulse waveform analysis (aPWA) and markers of peripheral artery ischemia were among the most commonly examined. The aim of the current study was to assess the relationship between potential predictors of clinical outcomes after peripheral artery PTA during a 1-year follow-up period. Methods: The study included 72 individuals with PAD at a mean age of 66.3 ± 7.2 (79.1% males). All patients underwent PTA of the peripheral arteries. Among them, 42.8% presented critical limb ischemia (CLI). During the first visit and at 1 month and 6 months after PTA, endothelial function and aPWA measurements were taken. Ankle-brachial index (ABI), toe-brachial index (TBI) and physical evalu­ation of the limbs took place during the first visit and at 1, 6 and 12 months after the PTA. The study endpoints included myocardial infarction, amputation, death, stroke and reintervention. All subjects included in the study were observed for 386 days after the PTA. Results: A significant improvement was noted in walking distance after PTA at the following time points, as well as transient improvement of ABI and flow-mediated dilatation (FMD) and no significant change in aPWA indices and reactive-hyperaemia index (RHI). The mean ABI, TBI, FMD and RHI values did not correlate with each other at baseline. There were 25 study endpoints which occurred in 16 patients during the follow-up period (22.2%). Patients with CLI, hypercholesterolemia, lower dias­tolic blood pressure, higher subendocardial viability ratio, a greater number of pack-years and lower TBI at baseline presented significantly poorer clinical outcomes in terms of endpoint events. Conclusions: Endothelial function assessed as FMD and reactive hyperemia–peripheral arterial tonometry (RH-PAT) before PTA in patients with advanced PAD do not predict clinical outcomes during the 1-year follow-up

Postocclusive hyperemia measured with laser Doppler flowmetry and transcutaneous oxygen tension in the diagnosis of primary Raynaud's phenomenon : a prospective, controlled study

The aim of this study was to measure the sensitivity and specificity of transcutaneous oxygen tension and postocclusive hyperemia testing using laser Doppler flowmetry in patients with primary Raynaud’s phenomenon. One hundred patients and one hundred controls were included in the study. Baseline microvascular blood flow and then time to peak flow following occlusion were measured using laser Doppler flowmetry. Afterwards, the transcutaneous oxygen tension was recorded. The sensitivities of baseline microvascular blood flow, postocclusive time to peak flow, and transcutaneous oxygen tension were 79%, 79%, and 77%, respectively. The postocclusive time peak flow had a superior specificity of 90% and area under the curve of 0.92 as compared to 66% and 0.80 for baseline microvascular flow and 64% and 0.76 for transcutaneous oxygen tension. Time to postocclusive peak blood flow measured by laser Doppler flowmetry is a highly accurate test for differentiating patients with primary Raynaud’s phenomenon from healthy controls

Vascular iInflammatory markers as predictors of peripheral arterial disease patients’ quality-of-life changes after endovascular treatment

The association between chronic inflammation and depression, anxiety, anhedonia, and quality of life (QoL) has been recently emphasized. However, the pathophysiology of this relationship remains unsolved. This study aims to assess the dependence between vascular inflammation represented by eicosanoid concentration and quality of life in patients with peripheral arterial disease (PAD). A total of 175 patients undergoing endovascular treatment due to lower limbs ischemia were covered with eight years of observation after the endovascular procedure, including ankle-brachial index (ABI), color Doppler ultrasound examination, urinary leukotriene E4 (LTE4), thromboxane B2 (TXB2) and 5-Hydroxyeicosatetraenoic acid (5-HETE) measurement and quality-of-life assessment with VascuQol-6. The baseline concentrations of LTE4 and TXB2 reversely correlated with preoperative VascuQol-6 and were predictive of the postoperative values of VascuQol-6 at each follow-up. At every follow-up timepoint, the results of VascuQol-6 reflected the LTE4 and TXB2 concentrations. Higher concentrations of LTE4 and TXB2 were correlated with lower life quality during the next follow-up meeting. Changes in VascuQol-6 at eight years vs. preoperative values were reversely related to the preoperative concentrations of LTE4 and TXB2. This is the first study to confirm that changes in life quality in PAD patients undergoing endovascular treatment are highly dependent on eicosanoid-based vascular inflammation

Dynamics of below-the-knee arterial blood flow after endovascular revascularization of peripheral arteries as a potential predictor of clinical outcomes during a one-year follow-up period

Background: Patients with advanced lower limb ischaemia are, at present, mainly treated using revascularisation. Aims: The aim of the study was to investigate whether the dynamics of blood flow in below-the-knee (BTK) arteries assessed by angiography correlate with clinical outcomes after a 12-month follow-up in patients with severe leg ischaemia treated per­cutaneously. Methods: The current study enrolled 287 consecutive patients who underwent 302 endovascular procedures on the infrain­guinal arteries. The mean age of the included participants was 67.4 ± 10.4 years. After the procedure, blood flow in all patent BTK arteries was assessed using frame count (FC). Patients were then evaluated after one, three, six, and 12 months. During the follow-up visits, clinical condition was evaluated based on the Rutherford scale, ankle-brachial index, and the need for reintervention or amputation. Results: Clinical improvement at the end of the follow-up period was observed in 242 (80.1%) cases and no improvement or worsening in was seen in 42 (13.0%) patients. In total, 66 (21.8%) reinterventions and 18 (6%) amputations during the follow-up period were recorded. Patients with higher FC in the tibial anterior artery experienced significantly better clinical improvement within the 12-month follow-up period (p = 0.02). Lower FC predisposed to worse clinical outcomes after an­gioplasty. Similar tendencies were found for the tibial posterior and fibular arteries but without statistical significance. Conclusions: The results suggest a negative relationship between FC observed on the final angiogram and clinical outcomes in patients undergoing endovascular treatment of the peripheral arteries

Leukotrienes in the atherosclerotic cardiovascular diseases — a systematic review

Introduction: The role of inflammation in the pathogenesis of atherosclerotic diseases is strongly suggested.There are multiple studies indicating the possibility of a pathophysiological connection between atheroscleroticchanges and leukotrienes (LTs) — the products of arachidonic acid metabolism. The goal of this systematicreview, performed in line with the PRISMA statement, was to investigate the potential role of LTs in the pathophysiologyof atherosclerotic cardiovascular diseases (CVD). Material and methods: The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews weresearched to identify the potentially eligible studies. Publications that contained information on any type of LTsidentified in blood or urine were included in the review. A database search identified 2082 records. Reliable LTsidentification in patients with CVD was used in 30 publications. Results: Stable and acute forms of coronary artery disease are characterized by the overproduction of differenttypes of LTs. The level of LTB4 and LTC4 in the blood is elevated in patients with cerebral ischemia. Patients withacute and chronic peripheral artery disease have elevated levels of LTE4 in urine. Conclusions: The findings of this systematic review show that there is a clear tendency to indicate the associationof cardiovascular atherosclerotic diseases with increased production of LTs. This dependency detailedcharacteristic remains unclear and the question on the impact of elevated leukotrienes on clinical atheroscleroticdisease manifestations is still open

Endovascular treatment of iatrogenic central vein stenosis and occlusion in patients undergoing haemodialysis : a two-year follow-up

Objectives: The objective of our report was to present the results of two-year follow-up of endovascular treatment of central venous occlusive disease in haemodialysis patients. Material and methods: Eighty-one consecutive patients with central venous occlusive disease, were included into the study group. There were 81 lesions treated (42 stenosis and 39 occlusions). Percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty with stenting (PTS) was committed. There was no randomisation. Stent implantation was avoided in vessels with a foreign body inside (catheter or electrode). Diagnostic phlebographies were performed after 12 and 24 months or if symptoms recurred. The follow-up period lasted for 24 months. There were 26 (70%) patients with primary stenosis and 11 (29%) with occlusion in the group with PTA therapy and 13 (38%) and 21 (61%) in the group with PTS therapy. Procedure was successful in all cases of stenosis, unsuccessful in 10 cases of occlusions. Seventeen patients died during first year of observation, 9 during the second. Two patients were lost to follow up. No serious adverse events were observed. Results: Primary patency (PP) after 12 and 24 months was 50% and 26% after PTS, 33% and 21% after PTA respectively. Primary assisted patency (PAP) was 70% and 52% in PTS group while 86% and 92% in PTA group. Secondary patency (SP) 70% and 52% after PTS to 93% and 92% after PTA. Conclusions: Both methods are safe and mildly effective in the treatment of central veins in haemodialysis patients. Both techniques should be applicable in specific clinical settings according to patient status and operator experience

Influence of endovascular treatment on the vascular endothelium in patients with peripheral arterial disease: a systematic review

Peripheral arterial disease (PAD) is a major public health problem. Endothelial dysfunction represents an important mechanism in the development and progression of atherosclerosis, in part attributable to inflammation, platelet and smooth muscle activation, and arterial stiffening. The aim of this study was to explore the impact of lower limb revascularization on endothelial function in patients with PAD. We performed a comprehensive search of the academic literature using the PubMed and Embase databases to screen suitable records. Following the application of our search strategies, a total of eight studies were included in this review. Despite the limited available evidence, the dearth of academic literature suggests that revascularization has a positive effect on endothelial functioning. The effects of endovascular revascularization on endothelial functioning in patients with PAD are subject to further research