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Watanabe Y, Shimizu Y, Hashimoto T, Iwahashi T, Shigematsu K, Nakaoka Y, Harigai M. Demographic Traits, Clinical Status, and Comorbidities of Patients With Thromboangiitis Obliterans in Japan. Circ J 2024; 88:319-328. [PMID: 37423757 DOI: 10.1253/circj.cj-23-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND The latest demographics, clinical and living conditions, and comorbidities of patients with thromboangiitis obliterans (TAO) in Japan are unknown.Methods and Results: We conducted a retrospective cross-sectional survey using the annual database of the Japanese Ministry of Health, Labour and Welfare medical support system for patients with TAO between April 2013 and March 2014. This study included 3,220 patients (87.6% male), with current age ≥60 years in 2,155 patients (66.9%), including 306 (9.5%) patients aged ≥80 years. Overall, 546 (17.0%) had undergone extremity amputation. The median interval from onset to amputation was 3 years. Compared with never smokers (n=400), 2,715 patients with a smoking history had a higher amputation rate (17.7% vs. 13.0%, P=0.02, odds ratio [OR]=1.437, 95% confidence interval [CI]=1.058-1.953). A lower proportion of workers and students was seen among patients after amputation than among amputation-free patients (37.9% vs. 53.0%, P<0.0001, OR=0.542, 95% CI=0.449-0.654). Comorbidities, including arteriosclerosis-related diseases, were found even in patients in their 20-30 s. CONCLUSIONS This large survey confirmed that TAO is not a life-threatening but an extremity-threatening disease that threatens patients' professional lives. Smoking history worsens patients' condition and extremity prognosis. Long-term total health support is required, including care of extremities and arteriosclerosis-related diseases, social life support, and smoking cessation.
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Affiliation(s)
| | - Yuuki Shimizu
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takuya Hashimoto
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare, Mita Hospital
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine
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Xue S, Zhang X, Peng Z, Wu X, Peng Z, Qin J, Lu X. Assessment of atherectomy treatment for Thromboangiitis Obliterans: A single center experience. Catheter Cardiovasc Interv 2023; 102:713-720. [PMID: 37706639 DOI: 10.1002/ccd.30801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/29/2023] [Accepted: 07/28/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND AIMS Endovascular recanalizaiton (ER) has been proven to be a feasible method for Thromboangiitis Obliterans (TAO). The aims of this study were to evaluate the effectiveness and safety of atherectomy for TAO compared to nonatherectomy ER in our center. METHODS Patients diagnosed as TAO were reviewed from January 2016 to June 2021 in our center. Basic characteristics of patients before ER and perioperative data were collected and compared between the atherectomy and nonatherectomy groups. The vascular event-free survival and limb salvage were calculated to evaluate the prognosis of TAO patients after ERs. Logistic Regression and Cox Regression were used to identify the risk factors for technical failure and prognosis, respectively. RESULTS Seventy-two TAO patients with 79 lower limbs who met the criteria were included in this report. Compared with the nonatherectomy group, no significant improvement was identified in ER technical success, vascular event-free survival, or limb salvage in the atherectomy group. The total technical success rate was 91.1% (atherectomy group, 95.2%; nonatherectomy group, 89.7%), and the multiple limb involvement (p = 0.005; odds ratio [OR], 28.16; confidence interval [CI], 3.28-241.55) was the independent risk factor for technical failure. The total vascular event-free survival proportion was 66.05% and 58.40% at 1 and 3 years, respectively. Technical failure (OR, 5.61; 95% CI, 1.57-20.04; p = 0.008), and runoff grade 0 (OR, 3.28; 95% CI, 1.09-9.85; p = 0.034) were independent risk factors for vascular events. The total limb salvage proportion at 1 and 3 years was 95.84% and 92.53%, respectively. Technical failure (OR, 8.54; 95% CI, 1.71-40.73; p = 0.02) was identified as an independent risk factor for above ankle amputation. CONCLUSIONS No significant difference in prognosis was found between the atherectomy group and the nonatherectomy group during a midterm follow-up. The technical success of ER was crucial for TAO prognosis.
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Affiliation(s)
- Song Xue
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xing Zhang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Zhaoxi Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xiaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
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Fazeli B, Poredos P, Kozak M, Pecsvarady Z, Catalano M, Al Salman MM, Altarazi L, Ali AA, Bashar AH, Bozkurt K, Cacione D, Chua B, Cvjetko I, Desai S, Erer D, Farkas K, Gaddikeri P, Geroulakos G, Guclu O, Hussein E, Ionac M, Iwai T, Karahan O, Kashani D, Kota A, Kroger K, Kubat E, Kumar PP, Lang W, Lobastov K, Malecki R, Marcoccia A, Ozbakkaloglu A, Pandey SR, Patel M, Polat A, Rajeev A, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sanri US, Sermsathanasawadi N, Sharebiani H, Stanek A, Stephen E, Szuba A, Taha W, Taheri H, Wautrecht JC, Yuwono HS, Zor MH, Liew A. Diagnostic criteria for Buerger's disease: International Consensus of VAS - European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2023; 42:396-401. [PMID: 38010012 DOI: 10.23736/s0392-9590.23.05098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.
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Affiliation(s)
- Bahare Fazeli
- Support Association of Patients of Buerger's Disease (Buerger's Disease NGO), Mashhad, Iran
| | - Pavel Poredos
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Matija Kozak
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Zsolt Pecsvarady
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Mariella Catalano
- Inter-University Research Center on Vascular Disease, Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | | | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abrar A Ali
- South Surgical Department, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Abul H Bashar
- Department of Vascular Surgery, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh
| | - Kursat Bozkurt
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Türkiye
| | - Daniel Cacione
- Unit of Vascular and Endovascular Surgery, Department of Surgery, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil
| | - Benjamin Chua
- Vascular and Interventional Center of Singapore, Novena Specialist Center, Singapore, Singapore
| | - Ivan Cvjetko
- Department of Vascular Surgery, Merkur University Hospital, Zagreb, Croatia
| | - Sanjay Desai
- Department of Vascular and Endovascular Surgery, Ramaiah Medical College Hospital, Bangalore, India
| | | | - Katalin Farkas
- Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
| | | | - Georgios Geroulakos
- Department of Vascular Surgery, National and Kapodestrian University, Athens, Greece
| | - Orkut Guclu
- Department of Cardiovascular Surgery, Medical School of Trakya University, Edirne, Türkiye
| | - Emad Hussein
- Department of Vascular Surgery, Ain Shams University, Cairo, Egypt
| | - Mihai Ionac
- Department of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Oguz Karahan
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya, Türkiye
| | - Daniel Kashani
- Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Albert Kota
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Knut Kroger
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Emre Kubat
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Prabhu P Kumar
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Werner Lang
- Department of Vascular Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Rafal Malecki
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Antonella Marcoccia
- Angiology and Autoimmunity Medical Unit, Rare Diseases Reference Center for Systemic Sclerosis, Sandro Pertini Hospital, Rome, Italy
| | - Alper Ozbakkaloglu
- Department of Cardiovascular Surgery, Özel Sağlık Hastanesi, İzmir, Türkiye
| | - Sandeep R Pandey
- Department of Vascular and Endovascular Surgery, Annapurna Hospital, Kathmandu, Nepal
| | - Malay Patel
- Department of Vascular Surgery, Apollo-CVHF Hospital, Ahmedabad, India
| | - Adil Polat
- Department of Cardiovascular Surgery, University of Health Sciences, İstanbul Bagcilar Research and Training Hospital, Istanbul, Türkiye
| | | | - Hassan Ravari
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vimalin Samuel
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Gerit Schernthaner
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Umut S Sanri
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hiva Sharebiani
- Support Association of Patients of Buerger's Disease (Buerger's Disease NGO), Mashhad, Iran
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Edwin Stephen
- Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Andrzej Szuba
- Department of Angiology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wassila Taha
- Non Invasive Vascular Lab, Al Salam Hospital, Cairo, Egypt
| | - Hossein Taheri
- Department of General Surgery, Farabi Hospital, Mashhad, Iran
| | - Jean-Claude Wautrecht
- Service of Vascular Pathology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Hendro S Yuwono
- Department of Vascular Surgery, School of Medicine, Islamic University of Bandung, Bandung, Indonesia
| | - Mustafa H Zor
- Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Aaron Liew
- University of Galway & Portiuncula University Hospital, Saolta University Health Care, Galway, Ireland -
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Sow M, Saadoun D, Cacoub P, Le Joncour A. Screening for Lung Cancer by Chest Computed Tomography During Thromboangiitis Obliterans. Angiology 2023:33197231203575. [PMID: 37729868 DOI: 10.1177/00033197231203575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Buerger's disease or thromboangiitis obliterans (TAO) is a non-atherosclerotic inflammatory arteritis strongly associated with smoking exposure. This tobacco use would expose patients to lung cancer. The French-speaking thoracic cancer intergroup recommends screening for lung cancer with a chest computed tomography (CT). Our study aims to evaluate lung cancer screening using chest CT during TAO. Ninety-seven TAO patients were included. The mean age of onset of TAO symptoms was 36.5 ± 10 years, and 73 (75%) were male. The mean follow-up was 8.5 ± 14 years. Overall, at least one chest CT was performed during follow-up in 32 (33%) patients. Twenty-three of the thirty-four (68%) patients who were over 50 at follow-up did not have a CT. An abnormality was found in 15 of the 32 (47%) patients who had a CT: lung nodules 6/15, lung mass 1/15, emphysema 6/15, and others 2. Two cases of lung adenocarcinoma were diagnosed. None died during 2 years follow-up. In conclusion, two-third of the TAO patients over 50 years of age did not receive the routine screening recommended in the general smoking population. Two cases of lung cancer have been diagnosed. Improving screening practices for lung cancer in this high-risk population is crucial.
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Affiliation(s)
- Maïmouna Sow
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
| | - David Saadoun
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
| | - Patrice Cacoub
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
| | - Alexandre Le Joncour
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
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Bae M, Chung SW, Lee J, Kim E, Kang G, Jin M. Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans. J Chest Surg 2023; 56:328-335. [PMID: 37248718 PMCID: PMC10480401 DOI: 10.5090/jcs.22.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Background Thromboangiitis obliterans (TAO) poses a higher risk of amputation than atherosclerosis obliterans. It is characterized by onset at a relatively young age. There are currently no clear treatment guidelines for TAO other than smoking cessation. In this study, we aimed to identify factors that could influence a favorable prognosis of TAO. Methods From January 2009 to December 2019, we retrospectively reviewed the initial symptoms, characteristics, treatments, and disease course of 37 patients (45 limbs) with TAO. Logistic regression analysis was performed to investigate factors affecting the course of symptoms that persisted or worsened despite treatment. Results Patients' mean age was 37.2±11.4 years, and all patients were men. The mortality rate was 0% during the follow-up period (76.9±51.1 months). All patients were smokers at the time of diagnosis, and 19 patients (51.4%) successfully quit smoking during treatment. When comparing the Rutherford categories before and after treatment, 23 limbs (51.1%) showed improvement, the category was maintained in 11 limbs (24.4%), and 11 limbs (24.4%) worsened. Symptom persistence or exacerbation despite treatment was associated with a higher initial Rutherford category (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.04-2.42; p=0.03) and a higher score of the involved below-knee artery at the time of diagnosis (OR, 2.26; 95% CI, 1.10-4.67; p=0.03). Conclusion The degree of disease progression at the time of diagnosis significantly affected patients' prognosis. Therefore, early diagnosis and intervention are important to improve the course of TAO.
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Affiliation(s)
- Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Woon Chung
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunji Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gayeon Kang
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moran Jin
- Department of Thoracic and Cardiovascular Surgery, Mokpo Hankook Hospital, Mokpo, Korea
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Komiya D, Iwai K, Ohno T. Efficacy of Supervised Exercise Therapy for Intermittent Claudication in a Case With Buerger's Disease. Cureus 2023; 15:e43537. [PMID: 37719627 PMCID: PMC10501807 DOI: 10.7759/cureus.43537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Herein, we report a case of intermittent claudication (IC) caused by Buerger's disease (thromboangiitis obliterans {TAO}), which we treated using supervised exercise therapy (SET). The patient was a 58-year-old male with a history of smoking who presented with IC and resting pain in the right lower extremity, which had led to necrosis of the right first toe eight years prior to presentation. The non-healing right first toe was amputated and the patient underwent angiogenesis therapy in the right lower extremity. Despite continued strict smoking cessation and antiplatelet medication, the patient presented with IC of the left lower extremity eight years after the previous symptoms. Therefore, the patient underwent SET once a week (40 min per session) for five months, resulting in a total of 21 sessions. Consequently, the patient's walking ability and quality of life (QoL) significantly improved. These results suggest that SET is an effective treatment for TAO-induced IC. However, further studies are required to demonstrate its efficacy.
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Affiliation(s)
- Daisuke Komiya
- Division of Rehabilitation, Omuta City Hospital, Fukuoka, JPN
| | - Kohji Iwai
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Aichi, JPN
| | - Tomokazu Ohno
- Division of Vascular Surgery, Omuta City Hospital, Fukuoka, JPN
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Clement E, Tjiattas-Saleski L. A 61-year-old with heavy tobacco use. J Am Coll Emerg Physicians Open 2023; 4:e12921. [PMID: 36896018 PMCID: PMC9990156 DOI: 10.1002/emp2.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Ethan Clement
- Department of Clinical Affairs UAMS College of Medicine, University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Lindsay Tjiattas-Saleski
- Department of Emergency PRISMA Health Upstate-Greenville Greenville South Carolina USA.,Department of Clinical Affairs Edward Via College of Osteopathic Medicine Spartanburg South Carolina USA
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8
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Çelik E, Çora AR. The Reliability and Quality of YouTube Videos as a Source of Information on Buerger's Disease: A Cross-Sectional Study. Ann Vasc Surg 2023; 90:144-152. [PMID: 36442712 DOI: 10.1016/j.avsg.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients are increasingly referring to the internet after a diagnosis of vascular disease. This study was performed to quantitatively define the accuracy and reliability of information on YouTube regarding Buerger's Disease (BD). METHODS A systematic search of YouTube was conducted using BD and thromboangiitis obliterans keywords. The default YouTube search setting of "relevance" was used to replicate an average search attempt, and the first 50 results from each keyword search were reviewed and analyzed by 2 independent reviewers. Descriptive characteristics, Journal of the American Medical Association Score (JAMAS), modified DISCERN score, Global Quality Score (GQS) were used to record data. RESULTS A total of 50 videos were reviewed for the study. The mean JAMAS, modified DISCERN, and GQS values among the videos were 2.06/4.00 (standard deviation [SD], 0.91), 2.36/5.00 (SD, 1.39), and 2.6/5.00 (SD, 1.16) respectively. When the videos were analyzed according to the user types uploading them, the modified DISCERN score was found to be significantly higher (3.57/5.00 SD, 0.97) in the videos uploaded by vascular surgeons (P = 0.029). High-quality videos were determined as more recent (P = 0.048). It was observed that the modified DISCERN and JAMA scores increased as the video quality increased. CONCLUSIONS While variable in source and content, the completeness and reliability of the information presented on YouTube about BD is poor. We believe that these videos should be uploaded more up-to-date and comprehensively by medical professionals, especially medical doctors.
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Affiliation(s)
- Ersin Çelik
- Clinic of Cardiovascular Surgery, Isparta City Hospital, Isparta, Turkey.
| | - Ahmet Rıfkı Çora
- Clinic of Cardiovascular Surgery, Isparta City Hospital, Isparta, Turkey
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9
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Carneiro FCF, Almeida BM, Cacione DG. Endovascular treatment for thromboangiitis obliterans (Buerger’s disease). Cochrane Database Syst Rev 2023; 2023:CD014886. [PMCID: PMC9885982 DOI: 10.1002/14651858.cd014886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness and safety of endovascular treatment for thromboangiitis obliterans (Buerger’s disease).
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Affiliation(s)
| | | | - Beatriz M Almeida
- Division of Vascular and Endovascular Surgery, Department of SurgeryUNIFESP – Escola Paulista de MedicinaSão PauloBrazil
| | - Daniel G Cacione
- Division of Vascular and Endovascular Surgery, Department of SurgeryUNIFESP – Escola Paulista de MedicinaSão PauloBrazil
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10
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Deroux A, Madelon A, Colombe B, Lugosi M, Bouillet L. [An alarming necrosis]. Rev Med Interne 2022; 43:752-754. [PMID: 36460440 DOI: 10.1016/j.revmed.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/27/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022]
Affiliation(s)
- A Deroux
- Service de médecine interne et polyvalente, CHU Grenoble-Alpes, 38000 Grenoble, France.
| | - A Madelon
- Service de médecine interne et polyvalente, CH de Briançon, 05100 Briançon, France
| | - B Colombe
- Service de médecine interne et polyvalente, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - M Lugosi
- Service de médecine interne et polyvalente, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - L Bouillet
- Service de médecine interne et polyvalente, CHU Grenoble-Alpes, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France
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Seitz L, Seitz P, Pop R, Lötscher F. Spectrum of Large and Medium Vessel Vasculitis in Adults: Primary Vasculitides, Arthritides, Connective Tissue, and Fibroinflammatory Diseases. Curr Rheumatol Rep 2022; 24:352-370. [PMID: 36166150 PMCID: PMC9513304 DOI: 10.1007/s11926-022-01086-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review To provide a comprehensive overview of the spectrum of large and medium vessel vasculitis in adults with primary vasculitides, arthritides, connective tissue, and fibroinflammatory diseases as well as vasculitis mimics, for an efficient differential diagnosis and initial diagnostic approach. Recent Findings Imaging has had a tremendous impact on the diagnosis of medium to large vessel vasculitis, now often replacing histopathologic confirmation and identifying new disease manifestations (e.g., intracranial disease in giant cell arteritis; vascular manifestations of IgG4-related disease). Novel diseases or syndromes involving blood vessels have been described (e.g., VEXAS-Syndrome with polychondritis). The use of the terms “medium” or “large” vessel varies considerably between medical specialties. Summary The differential diagnosis of large and medium vessel vasculitis is becoming increasingly complex as new entities or disease manifestations of known inflammatory rheumatic diseases are regularly identified. A more precise and widely recognized definition of the vessel sizes would make future research more comparable.
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Affiliation(s)
- Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.
| | - Pascal Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Roxana Pop
- Department of Infectious Diseases and Hospital Hygiene, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
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12
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Momen Majumder MS, Ahmed S, Haque T, Haq SA, Chakravarty S, Shahin MA, Osmany DMF, Rasker JJ, Nakajima H. Digital Gangrene: An Unusual Manifestation of Non-Hodgkin Lymphoma. Case Rep Vasc Med 2022; 2022:1-9. [PMID: 35284148 PMCID: PMC8906966 DOI: 10.1155/2022/8963753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Non-Hodgkin lymphomas (NHLs) comprise a group of haematologic malignancies with different histologic subtypes. The clinical picture varies from indolent to aggressive presentation and nodal (lymphadenopathy) to extranodal (central nervous system, gastrointestinal, cutaneous plaque, or ulcer) involvement. Digital gangrene is seldom reported. Here, we describe a patient with pain and blackening of all fingers and toes as presenting symptoms of NHL. Case Presentation. A 32-year-old male weaver had been smoking three to five cannabis-containing cigarettes daily for about ten years and methamphetamine four to five tablets daily for five years. He had no history of Raynaud's phenomenon, fever, cough, weight loss, skin rash, joint pain, and atherogenic or thrombogenic risk factors. We found normal blood pressure and absent peripheral pulses in arms and legs, dry gangrene of all fingers and toes, generalized lymphadenopathy, and hepatomegaly with ascites. The chest X-ray was normal, as were blood sugar, lipid profile, and hepatic and renal function. Rheumatoid factor, antinuclear and antiphospholipid antibodies, C-ANCA and P-ANCA, hepatitis B and C, and HIV were negative. CT abdomen revealed hepatosplenomegaly with multiple intra-abdominal lymphadenopathies. The peripheral angiogram showed 90-99% stenosis of radial and dorsalis pedis arteries with normal proximal vessels. Diagnosis of non-Hodgkin lymphoma was confirmed by histopathology of cervical lymph node (diffuse type), immunohistochemically subtyped as peripheral T cell lymphoma (not otherwise specified). The digital ischemia worsened despite cessation of cannabis and methamphetamine and starting CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) treatment, making amputation necessary. Conclusion We present, to our knowledge, the first report of peripheral T cell lymphoma, NOS presenting with gangrene in all digits complicated by methamphetamine and cannabis abuse. This uncommon vascular manifestation of non-Hodgkin lymphoma may cause a diagnostic dilemma and delayed initiation of treatment.
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Lee SA, Jeong MJ, Ko GY, Hwang HS, Gwon DI, Choi E, Kwon TW, Cho YP. Long-term outcomes of large artery thromboangiitis obliterans and comparison with small artery thromboangiitis obliterans. Medicine (Baltimore) 2022; 101:e28512. [PMID: 35029910 PMCID: PMC8735778 DOI: 10.1097/md.0000000000028512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022] Open
Abstract
Although the distribution of arterial involvement is still the subject of controversy for defining the diagnostic criteria for thromboangiitis obliterans (TAO), several reports have described TAO involving the more proximal arterial segment. This study aimed to investigate the clinical characteristics and outcomes of large artery TAO in comparison with those of small artery TAO.Between January 2007 and July 2019, 83 consecutive symptomatic patients with a diagnosis of lower extremity TAO were stratified according to the most proximal arterial involvement, with the cutoff level of the adductor canal as a reference (large artery TAO versus small artery TAO), and analyzed retrospectively. The study outcomes included any amputations and major amputations.The large artery TAO group consisted of 30 patients (36.1%), and the small artery TAO group consisted of 53 patients (63.9%). In terms of clinical symptoms and signs, the proportion of major tissue loss (Rutherford class 6) was significantly higher among patients with large artery TAO than among those with small artery TAO (13.3% versus 0%, P = .02). Any amputation rate was similar between the large and small artery TAO groups during the median follow-up period of 148 months (range, 0-376 months) (43.3% versus 28.3%, P = .16). However, the major amputation rate was significantly higher among patients with large artery TAO (13.3% versus 0%, P = .02). On Kaplan-Meier survival analysis of the cumulative event-free rates, although there was a similar 10-year amputation-free survival rate (P = .24) between the 2 groups, the large artery TAO group had a significantly lower 10-year major amputation-free survival rate (P < .01) than the small artery TAO group.Large artery TAO is a limb-threatening condition and had a worse prognosis than small artery TAO.
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Affiliation(s)
- Sang Ah Lee
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Min-Jae Jeong
- Department of Surgery, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Hee Sang Hwang
- Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Eol Choi
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Won Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Pil Cho
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
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14
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Ribieras AJ, Ortiz YY, Liu ZJ, Velazquez OC. Therapeutic angiogenesis in Buerger's disease: reviewing the treatment landscape. Ther Adv Rare Dis 2022; 3:26330040211070295. [PMID: 37180424 PMCID: PMC10032470 DOI: 10.1177/26330040211070295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/07/2021] [Indexed: 05/16/2023]
Abstract
Thromboangiitis obliterans, also known as Buerger's disease, is a rare inflammatory vasculitis that predominantly develops in smokers and characteristically affects the small- and medium-sized peripheral arteries and veins. Patients typically present with extremity claudication, but symptoms may progress to rest pain and tissue loss, especially in those unable to abstain from tobacco use. Unfortunately, traditional medical treatments are largely ineffective and due to the small caliber of affected vessels and lack of suitable distal targets or venous conduits, endovascular and open surgical approaches are often not possible. Eventually, a significant number of patients require major amputation. For these reasons, much research effort has been made in developing techniques of therapeutic angiogenesis to improve limb perfusion, both for atherosclerotic peripheral arterial disease and the smaller subset of patients with critical limb ischemia due to Buerger's disease. Neovascularization in response to ischemia relies on a complex interplay between the local tissue microenvironment and circulating stem and progenitor cells. To date, studies of therapeutic angiogenesis have therefore focused on exploiting known angiogenic factors and stem cells to induce neovascularization in ischemic tissues. This review summarizes the available clinical data regarding the safety and efficacy of various angiogenic therapies, notably injection of naked DNA plasmids, viral gene constructs, and cell-based preparations, and describes techniques for potentiating in vivo efficacy of gene- and cell-based therapies as well as ongoing developments in exosome-based cell-free approaches for therapeutic angiogenesis. Plain Language Title and Summary A review of available and emerging treatments for improving blood flow and wound healing in patients with Buerger's disease, a rare disorder of blood vessels Buerger's disease is a rare disorder of the small- and medium-sized blood vessels in the arms and legs that almost exclusively develops in young smokers. Buerger's disease causes inflammation in arteries and veins, which leads to blockage of these vessels and reduces blood flow to and from the extremities. Decreased blood flow to the arms and legs can lead to development of nonhealing wounds and infection for which some patients may eventually require amputation. Unfortunately, traditional medical and surgical treatments are not effective in Buerger's disease, so other methods for improving blood flow are needed for these patients. There are several different ways to stimulate new blood vessel formation, both in humans and animal models. The most common treatments involve injection of DNA or viruses that express genes related to blood vessel formation or, alternatively, stem cell-based treatments that help regenerate blood vessels and repair wound tissue. This review explores how safe and effective these various treatments are and describes recent research developments that may lead to better therapies for patients with Buerger's disease and other vascular disorders.
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Affiliation(s)
- Antoine J. Ribieras
- DeWitt Daughtry Family Department of Surgery,
University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yulexi Y. Ortiz
- DeWitt Daughtry Family Department of Surgery,
University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zhao-Jun Liu
- DeWitt Daughtry Family Department of Surgery,
University of Miami Miller School of Medicine, RMSB 1046, 1600 NW 10th
Avenue, Miami, FL 33136, USA. Vascular Biology Institute, University of
Miami Miller School of Medicine, Miami, FL, USA
| | - Omaida C. Velazquez
- DeWitt Daughtry Family Department of Surgery,
University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami,
FL 33136, USA. Vascular Biology Institute, University of Miami Miller School
of Medicine, Miami, FL, USA
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15
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Chung MH, Lee JS, Kang JS. Buerger’s Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients. Infect Chemother 2022; 54:20-58. [PMID: 35384418 PMCID: PMC8987189 DOI: 10.3947/ic.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/26/2022] [Indexed: 12/03/2022] Open
Abstract
Buerger’s disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.
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Affiliation(s)
- Moon-Hyun Chung
- Division of Infectious Diseases, Department of Internal Medicine, Seogwipo Medical Center, Jeju, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine; Inha University, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea
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16
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Jiang X, Liu H, Pan T, Gu S, Fang Y, Wei Z, Fang G, Chen B, Jiang J, Shi Y, Liu P, Fu W, Dong Z. Long-Term Outcomes of Peripheral Blood Mononuclear Cells in the Treatment of Angiitis-Induced No-Option Critical Limb-Threatening Ischemia. Front Cardiovasc Med 2021; 8:769472. [PMID: 34938786 PMCID: PMC8687358 DOI: 10.3389/fcvm.2021.769472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Peripheral blood mononuclear cells (PBMNCs) showed encouraging short outcomes in the treatment of angiitis-induced no-option critical limb-threatening ischemia (AICLTI) in the pilot study. This study aimed to demonstrate the long-term outcomes of this treatment. Methods: From May 2014 to December 2018, patients diagnosed with AICLTI and treated by autotransplantation of PBMNCs in our center were enrolled and analyzed. The primary endpoint was major amputation-free survival (MAFS), the secondary endpoints included peak pain-free walking time (PPFWT), Wong-Baker FACES pain rating scale score (WFPRSS), labor recovery, ankle-brachial index (ABI), transcutaneous partial oxygen pressure (TcpO2), and SF-36v2 scores. Results: A total of 58 patients were enrolled. During a minimal follow-up of 36 months, the MAFS was 93.1% and the labor competence restored rate was 62.1%. The WFPRSS was decreased from 8.7 ± 1.6 to 1.6 ± 3.2, and PPFWT was significantly improved from 2.9 ± 4.2 min to 16.6 ± 6.9 min. The quality of life was also significantly improved at each follow-up point. Perfusion evaluating parameters, such as ABI and TcPO2, were also significantly improved. No critical adverse event was observed during the treatment and follow-up period. Conclusions: The treatment of AICLTI by autotransplantation of PBMNCs demonstrated encouraging long-term results. It could not only restore labor competence, improve the quality of life, but also significantly reduce the major amputation rate.
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Affiliation(s)
- Xiaolang Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Liu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyue Pan
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiyang Gu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Fang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zheng Wei
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gang Fang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junhao Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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17
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Wang W, Zhao T, Geng K, Yuan G, Chen Y, Xu Y. Smoking and the Pathophysiology of Peripheral Artery Disease. Front Cardiovasc Med 2021; 8:704106. [PMID: 34513948 PMCID: PMC8429807 DOI: 10.3389/fcvm.2021.704106] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/31/2021] [Indexed: 12/15/2022] Open
Abstract
Smoking is one of the most important preventable factors causing peripheral artery disease (PAD). The purpose of this review is to comprehensively analyze and summarize the pathogenesis and clinical characteristics of smoking in PAD based on existing clinical, in vivo, and in vitro studies. Extensive searches and literature reviews have shown that a large amount of data exists on the pathological process underlying the effects of cigarette smoke and its components on PAD through various mechanisms. Cigarette smoke extracts (CSE) induce endothelial cell dysfunction, smooth muscle cell remodeling and macrophage phenotypic transformation through multiple molecular mechanisms. These pathological changes are the molecular basis for the occurrence and development of peripheral vascular diseases. With few discussions on the topic, we will summarize recent insights into the effect of smoking on regulating PAD through multiple pathways and its possible pathogenic mechanism.
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Affiliation(s)
- Weiming Wang
- The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China.,Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Tingting Zhao
- The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Kang Geng
- The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Gang Yuan
- The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Youhua Xu
- The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
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18
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Soudet S, Bultel L, Adnane L, Reix T, Sevestre MA. Under-Prescription of Medical Treatment for Peripheral Artery Disease in the Under 50s: A Retrospective Study. Angiology 2021; 73:338-343. [PMID: 34486390 DOI: 10.1177/00033197211042155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral artery disease (PAD) is a common cause of morbidity and mortality; however, data on its etiology and evolution in patients under 50 years old are scarce. Therefore, we performed a retrospective analysis of data from medical records, including cardiovascular risk factors, etiology, medical and surgical treatment, and follow-up. We included all patients with PAD aged between 18 and 50 years attending our university hospital between 2005 and 2015. Of the 87 patients included, 32 (36%) were women. Smoking was acknowledged by 81 patients (93%), and 37 had dyslipidemia (42.5%). Median follow-up was 24 months (10-59). Recurrence occurred in 41 patients (47.1%), all active smokers, with a median delay of 14 months (7-47). Acute limb ischemia at diagnosis was significantly associated with major amputation, odds ratio (OR) 5.95 (95%CI 1.41-40.90, P = .029), which was needed by 11 patients (12.6%). Treatments included antiplatelet therapy (76; 87.4%), statins (67; 77%), and anti-hypertensives (60; 69%), and 29 (32.1%) patients benefited from vascular rehabilitation. This cohort of relatively young patients with PAD showed a high level of symptom recurrence. Atherosclerosis was the most common etiology. Our study revealed that medical treatment is often under-prescribed in this age group and needs to be improved.
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Affiliation(s)
- Simon Soudet
- Department of Vascular Medicine, 36673Amiens-Picardie University Hospital, Amiens, France.,EA CHIMERE, 7516, University Picardie Jules Verne, Amiens, France
| | - Lorène Bultel
- Department of Vascular Medicine, 36673Amiens-Picardie University Hospital, Amiens, France
| | - Lamrani Adnane
- Biostatistics, Clinical Research and Innovation Department, 36673Amiens-Picardie University Hospital, Amiens, France.,Rehabilitation Care Department, René Plevan Hospital, Dinan, Brittany, France
| | - Thierry Reix
- Department of Vascular Surgery, 36673Amiens-Picardie University Hospital, Amiens, France
| | - Marie Antoinette Sevestre
- Department of Vascular Medicine, 36673Amiens-Picardie University Hospital, Amiens, France.,EA CHIMERE, 7516, University Picardie Jules Verne, Amiens, France
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19
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Chapman S, Ballinger K, Chan MK, Stefanovici C, Rozovsky K, Boyd A, Vanan MI. Thromboangiitis Obliterans (Buerger's Disease) in an Adolescent Male. J Pediatr Hematol Oncol 2021; 43:e759-62. [PMID: 32925405 DOI: 10.1097/MPH.0000000000001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
Arterial occlusive disease of the limb is very rare in children. Buerger's disease (BD) is a nonatherosclerotic, segmental inflammatory arteritis affecting the small and medium-sized vessels of the extremities. We report BD in a 16-year-old male presenting with arterial insufficiency of left foot and history of smoking cigarettes and cannabis for 2 years. BD was diagnosed based on history of smoking in combination with clinical, laboratory, and radiologic findings. Pediatric hemato-oncologists should consider BD in the differential diagnosis in adolescents who smoke cigarettes and/or cannabis and present with vascular insufficiency of the hands and/or feet.
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20
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Fazeli B, Poredos P, Patel M, Klein-Weigel P, Catalano M, Stephen E, Al Salman MM, Altarazi L, Bashar AH, Chua B, Colgan MP, Cvjetko I, Desai S, Dimakakos EP, Erer D, Farkas K, Fowkes GR, Gerotziafas G, Hussein E, Ionac M, Iwai T, Karahan O, Kolossvary E, Kota A, Kozak M, Kroger K, Kumar PP, Liew A, Malecki R, Najafi MH, Olinic DM, Pandey SR, Pecsvarady Z, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sermsathanasawadi N, Sharebiani H, Stanek A, Szuba A, Taheri H, Wautrecht JC, Hakan Zor M. Milestones in thromboangiitis obliterans. A position paper of the VAS-European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2021; 40:395-408. [PMID: 34236154 DOI: 10.23736/s0392-9590.21.04712-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unfortunately, even today Thromboangiitis Obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. METHODS A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. RESULTS Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. CONCLUSIONS AND RELEVANCE An international group of experts however came to one conclusion. They all agree that management of TAO is in need of a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.
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Affiliation(s)
- Bahare Fazeli
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pavel Poredos
- Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia -
| | - Malay Patel
- Vascular Surgery Department, Apollo CVHF Hospital, Ahmedabad, India
| | - Peter Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Mariella Catalano
- Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
| | - Edwin Stephen
- Vascular Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mussaad M Al Salman
- Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abul H Bashar
- National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh
| | - Benjamin Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ivan Cvjetko
- James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Sanjay Desai
- Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia
| | - Evangelos P Dimakakos
- Department of vascular and endovascular surgery, Ramaiah Medical College Hospital, Bangalore, India
| | - Dilek Erer
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katalin Farkas
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | | | | | - Emad Hussein
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Mihai Ionac
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Takehisa Iwai
- Vascular surgery department, Ain Shams University, Cairo, Egypt
| | - Oguz Karahan
- Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, Romania
| | - Endre Kolossvary
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | - Albert Kota
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Matija Kozak
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
| | - Knut Kroger
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prabhu P Kumar
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Aaron Liew
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Rafal Malecki
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Mohammad H Najafi
- Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Dan M Olinic
- Department of Angiology, Systemic hypertension and diabetology
| | | | | | - Hasan Ravari
- Department of Cardiology, Tehran Medical Unit, Azad University, Tehran, Iran
| | - Vimalin Samuel
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Gerit Schernthaner
- Medical Clinic No 1, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dheepak Selvaraj
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | | | - Hiva Sharebiani
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Agata Stanek
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Andrzej Szuba
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Hossein Taheri
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean Claude Wautrecht
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Mustafa Hakan Zor
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Bergère G, Toquet C, Hoffmann C, Bressollette L, Raimbeau A, Durant C, Artifoni M, Gautier G, Hersant J, Connault J, Pistorius MA, Espitia O. Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans. VASA 2021; 50:301-305. [PMID: 33739143 DOI: 10.1024/0301-1526/a000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa's criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.
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Affiliation(s)
- Guillaume Bergère
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | | | - Clément Hoffmann
- Department of vascular medicine, EA 3878 GETBO, CHU de Brest, France
| | - Luc Bressollette
- Department of vascular medicine, EA 3878 GETBO, CHU de Brest, France
| | - Alizée Raimbeau
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Cécile Durant
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Mathieu Artifoni
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Giovanni Gautier
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Jeanne Hersant
- Department of internal and vascular medicine, CHU de Nantes, France
| | - Jérôme Connault
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Marc-Antoine Pistorius
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Olivier Espitia
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
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Abstract
Systemic vasculitides are multisystem blood vessel disorders, which are defined by the size of the vessel predominantly affected, namely small, medium, or large vessels. The term "large vessel" relates to the aorta and its major branches; "medium vessel" refers to the main visceral arteries and veins and their initial branches. The most common causes of large-vessel vasculitis are giant cell arteritis and Takayasu arteritis, and those of medium-vessel arteritis are polyarteritis nodosa and Kawasaki disease. However, there is some overlap, and arteries of any size can potentially be involved in any of the 3 main categories of dominant vessel involvement. In addition to multisystem vasculitides, other forms of vasculitis have been defined, including single-organ vasculitis (eg, isolated aortitis). Prompt identification of vasculitides is important because they are associated with an increased risk of mortality. Left undiagnosed or mismanaged, these conditions may result in serious adverse outcomes that might otherwise have been avoided or minimized. The ethnic and regional differences in the incidence, prevalence, and clinical characteristics of patients with vasculitis should be recognized. Because the clinical presentation of vasculitis is highly variable, the cardiovascular clinician must have a high index of suspicion to establish a reliable and prompt diagnosis. This article reviews the pathophysiology, epidemiology, diagnostic strategies, and management of vasculitis.
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Affiliation(s)
- David Saadoun
- Sorbonne Universités, Assistance Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Department of Internal Medicine and Clinical Immunology, Centre national de Référence des Maladies Auto-Immunes Systémiques Rares, Centre national de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France (D.S., M.V.).,Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de recherche (UMR) S 959, and Recherche Hospitalo-Universitaire en santé (RHU) Interleukin-2 Therapy for autoimmune and inflammatory diseases, Paris, France (D.S., P.C.)
| | - Mathieu Vautier
- Sorbonne Universités, Assistance Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Department of Internal Medicine and Clinical Immunology, Centre national de Référence des Maladies Auto-Immunes Systémiques Rares, Centre national de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France (D.S., M.V.)
| | - Patrice Cacoub
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de recherche (UMR) S 959, and Recherche Hospitalo-Universitaire en santé (RHU) Interleukin-2 Therapy for autoimmune and inflammatory diseases, Paris, France (D.S., P.C.)
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Li MD, Wang YF, Yang MW, Hong FF, Yang SL. Risk Factors, Mechanisms and Treatments of Thromboangiitis Obliterans: An Overview of Recent Research. Curr Med Chem 2021; 27:6057-6072. [PMID: 31419926 DOI: 10.2174/0929867326666190816233042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thromboangiitis obliterans (TAO) is a nonatherosclerotic thromboticocclusive vasculitis that affects the vessels of the small and medium-sized extremities. No explicit etiology or pathogenesis of TAO has been proven, and more effective treatments are needed. OBJECTIVE The study aimed to summarize and present an overview of recent advances regarding the risk factors, mechanisms and treatments of TAO and to organize the related information in figures to provide a comparatively complete reference. METHODS We searched PubMed for English-language literature about TAO without article type limits, including articles about the risk factors, pathological mechanisms and treatments of TAO in the last 10 years with essential supplements (references over ranges and English abstracts of Russian literature). RESULTS After screening content of works of literature, 99 references were evaluated. We found that risk factors of TAO include smoking, gene factors and periodontal diseases. The underlying mechanism of TAO involves oxidative stress, immunity, hemodynamic changes, inflammation and so on. Moreover, similarities in genetic factors and cigarette relevance existed between periodontal diseases and TAO, so further study of relationship was required. For TAO treatment, medicine, endovascular intervention and revascularization surgery, autologous cell therapy and novel therapies were also mentioned. Besides, a hypothesis that infection triggers autoimmunity in TAO could be speculated, in which TLR4 plays a key role. CONCLUSION 1. A hypothesis is put forward that infections can trigger autoimmunity in TAO development, in which TLR4, as a key agent, can activate immune signaling pathways and induce autoimmune cytokines expression. 2. It is suggested to reconsider the association between periodontal diseases and TAO, as they share the same high-risk population. Controlling periodontal disease severity in TAO studies may provide new clues. 3. For TAO treatment, endovascular intervention and autologous cell therapy both showed promising long-term therapeutic effectiveness, in which autologous cell therapy is becoming more popular, although more clinical comparisons are needed.
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Affiliation(s)
- Meng-di Li
- Department of Physiology, College of Medicine, Nanchang University, Nanchang 330006, China
| | - Yi-Fan Wang
- Institute of Cancer Research, Jiangxi Academy of Medical Science, Nanchang, Jiangxi 330006, China
| | - Mei-Wen Yang
- Department of Nursing, Nanchang University hospital, Nanchang, Jiangxi 330006, China
| | - Fen-Fang Hong
- Department of Experimental Teaching Center, Nanchang University, Nanchang 330031, China
| | - Shu-Long Yang
- Department of Physiology, College of Medicine, Nanchang University, Nanchang 330006, China
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24
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Li ZF, Shu XJ, Wang WH, Liu SY, Dang L, Shi YQ, Bai YW. Predictive value of serum VEGF, IL-1 and TNF-α in the treatment of thromboangiitis obliterans by revascularization. Exp Ther Med 2020; 20:232. [PMID: 33149786 PMCID: PMC7604734 DOI: 10.3892/etm.2020.9362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 01/20/2020] [Indexed: 12/20/2022] Open
Abstract
Effect of revascularization in the treatment of thromboangiitis obliterans (TAO) and the predictive value of serum vascular endothelial growth factor (VEGF), interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) of risk factors of amputation were investigated. From April 2012 to August 2015, a total of 117 patients with TAO admitted to the First Hospital of Lanzhou University were selected. Patients treated with revascularization combined with prostaglandin sodium and cilostazol were enrolled in group A (67 patients), and patients treated with sodium and cilostazol were enrolled in group B (50 patients). The clinical efficacy was evaluated by calculating the intermittent claudication distance and the ankle brachial index (ABI) of patients. The occurrence probability of nausea and vomiting, skin pruritus, abdominal pain, coagulation abnormalities and amputation were recorded. The concentration of serum VEGF, IL-1 and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). After treatment, the intermittent claudication distance, ABI and efficiency of group A was markedly higher than that of group B (P<0.05). After treatment, serum VEGF concentration in group A was clearly higher than that in group B (P<0.05), and IL-1 and TNF-α levels were much lower than those in group B (P<0.05). The amputation rate in group A was significantly lower than that in group B (P<0.05). Patients with amputation in both groups were enrolled in the study group (24 cases), and those without amputation were included in the control group (93 cases). The serum VEGF concentration in the study group before treatment was significantly lower than that in the control group (P<0.05), while IL-1 and TNF-α levels were significantly higher than those of the control group (P<0.05). In conclusion, pretreatment serum VEGF, IL-1 and TNF-α had a positive diagnostic value for poor prognosis of patients with amputation, and low concentration of VEGF and higher concentration of IL-1 and TNF-α are the risk factors for amputations in patients with TAO.
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Affiliation(s)
- Zheng-Fei Li
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Xiao-Jun Shu
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Wen-Hui Wang
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Sheng-Ye Liu
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Lei Dang
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Yan-Qiang Shi
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Yan-Wen Bai
- The Department of Interventional Radiology of The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
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Choi B, Jang SY, Kim SK, Kim N, Kim K, Kim DK. The incidence, prevalence, and survival rate of thromboangiitis obliterans in Korea: a retrospective population-based study. Cardiovasc Diagn Ther 2020; 10:1238-1244. [PMID: 33224747 DOI: 10.21037/cdt-20-582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Few studies used nationwide data to assess the age-standardized prevalence rate, incidence rate, 10-year survival rate, and death risk of thromboangiitis obliterans (TAO; Buerger's disease). Methods Data for 24,392 patients who had newly diagnoses related to TAO (I73.1) from 2006 through 2017 were extracted from the National Health Insurance Service in Korea. The age-standardized prevalence rate, incidence rate, 10-year survival rate, and death risk of TAO were analyzed. Results The mean (standard deviation) age of TAO patients overall was 62.0 (15.7) years; 61.3 (15.4) in males and 63.2 (16.1) in females (P<0.001). The proportion of patients older than 50 years old was about 80% overall. The proportion patients who died of TAO was 28.1%. Overall, the age-standardized prevalence rate of TAO decreased from 11.1 persons per 100,000 persons in 2006 to 8.43 persons in 2017, and overall, the incidence rate of TAO decreased from 6.07 persons in 2006 to 3.38 persons in 2017. The age-standardized prevalence rate and incidence rate in males were higher than that in females. The 10-year survival rate of TAO was about 65% (60.7% in males and 72.5% in females). The adjusted hazard ratio increased significantly with older age, male sex, hypertension, diabetes mellitus, myocardial infarction, heart failure, ischemic stroke, hemorrhagic stroke, chronic kidney disease, and malignant neoplasm. Conclusions The 10-year survival rate of TAO was about 65%. Even though the age-standardized prevalence rate and incidence rate of TAO is decreased during the study period, the adjusted hazard ratio showed significantly increases with age and with male sex after adjustment for comorbidities.
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Affiliation(s)
- Bareun Choi
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, Republic of Korea
| | - Shin Yi Jang
- Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, 81 Irwon-ro, Kangnam-gu, Seoul, Republic of Korea
| | - Seong-Kyong Kim
- Departmentof Orthopedic Surgery, Samsung Medical Center, 81 Irwon-ro, Kangnam-gu, Seoul, Republic of Korea
| | - Nari Kim
- Department of Nursing, Samsung Medical Center, 81 Irwon-ro, Kangnam-gu, Seoul, Republic of Korea
| | - Kyeongsug Kim
- Department of Nursing, Samsung Medical Center, 81 Irwon-ro, Kangnam-gu, Seoul, Republic of Korea
| | - Dong Kyu Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, 82 Gugwon-daero, Chungju, Republic of Korea
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26
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Watanabe Y, Miyata T, Shigematsu K, Tanemoto K, Nakaoka Y, Harigai M. Current Trends in Epidemiology and Clinical Features of Thromboangiitis Obliterans in Japan - A Nationwide Survey Using the Medical Support System Database. Circ J 2020; 84:1786-1796. [PMID: 32879220 DOI: 10.1253/circj.cj-19-1165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The epidemiology and clinical features of thromboangiitis obliterans (TAO) in Japan have not been updated extensively.Methods and Results:This retrospective study used the Japanese Ministry of Health, Labour and Welfare (JMHLW) medical support system database and associated health insurance data. The number of medical financial support recipients registered as TAO patients and estimated prevalence of TAO decreased from fiscal year (FY) 2000 (10,089 and 7.95 [95% confidence interval, CI: 7.79-8.10] per 100,000 population) to FY 2010 (7,147 and 5.58 [95% Cl: 5.45-5.71] per 100,000) and leveled off until 2014. The prevalence of TAO among patients with peripheral arterial occlusive diseases declined from 7.15% (95% Cl: 7.00-7.31) in FY 2008 to 6.12% (95% Cl: 5.98-6.26) in FY 2014. Clinicodemographic features were obtained from 89 new recipients in FY 2013 and 2014: 12 (13%) women, 36 (40%) aged ≥50 years, 26 (29%) had probable onset age ≥50 years, 7 (8%) were non-smokers, and 12 (13%) had arteriosclerosis-related comorbidities. The symptoms were similar regardless of registration age, smoking history, or sex. Although 40 (45%) had digit ulcers, only 12 (13%) fulfilled Shionoya's criteria. They rarely had infrapopliteal lesions combined with upper extremity involvement or phlebitis. CONCLUSIONS The prevalence of TAO has decreased in Japan. In the current diagnosis of TAO, various clinical characteristics including late onset, arteriosclerotic factors, non-smoking, or mild symptoms should be considered.
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Affiliation(s)
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare, Mita Hospital
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine
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Sharebiani H, Fazeli B, Maniscalco R, Ligi D, Mannello F. The Imbalance among Oxidative Biomarkers and Antioxidant Defense Systems in Thromboangiitis Obliterans (Winiwarter-Buerger Disease). J Clin Med 2020; 9:E1036. [PMID: 32272606 DOI: 10.3390/jcm9041036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Thromboangiitis obliterans or Winiwarter-Buerger disease (WBD), is an inflammatory, thrombotic occlusive, peripheral vascular disease, usually occurring in young smokers. The pathophysiological mechanisms underlying the disease are not clearly understood. The aim of this study is to investigate the imbalance between oxidants and antioxidants occurring in these patients. (2) Patients and Methods: In this cross-sectional study, 22 male patients with WBD and 20 healthy male smoking habit matched control group were included. To evaluate the possible sources of oxidative stress, the antioxidant biomarkers, and the markers of lipid peroxidation and protein oxidation, serum samples were analyzed for total oxidative status (TOS), total antioxidant capacity (TAC), myeloperoxidase (MPO), coenzyme Q10 (CoQ10), superoxide dismutase (SOD), glutathione reductase (GR), malondialdehyde (MDA), and protein carbonyl (PC) activity and/or content. (3) Results: The circulating levels of TOS, TAC, and CoQ10 were significantly higher in WBD patients, with respect to healthy smokers as controls. No significant difference was found among the serum level of PC, total cholesterol, MPO, and GR activity in WBD patients and healthy smoker controls. The activity of SOD and the mean serum level of MDA were significantly lower in WBD patients, with respect to healthy smoker controls. (4) Conclusion: Considerably high levels of oxidative stress were detected in WBD patients, which were greater than the antioxidant capacity. The low level of MDA may be associated with the enzymatic degradation of lipid peroxidation products. High levels of CoQ10 and low levels of SOD may be related to a harmful oxidative cooperation, leading to the vasoconstriction of WBD, representing a promising tool to discern possible different clinical risks of this poorly understood peripheral occlusive disease.
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28
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Mohamad Yusoff F, Kajikawa M, Takaeko Y, Kishimoto S, Hashimoto H, Maruhashi T, Kihara Y, Nakashima A, Higashi Y. Long-Term Clinical Outcomes of Autologous Bone Marrow Mononuclear Cell Implantation in Patients With Severe Thromboangiitis Obliterans. Circ J 2020; 84:650-655. [PMID: 32132348 DOI: 10.1253/circj.cj-19-1041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with severe Buerger disease, also known as thromboangiitis obliterans (TAO), are at risk of major limb amputation. It has been shown that autologous bone marrow mononuclear cell (BM-MNC) implantation improves the condition of critical limb ischemia in TAO patients. This study was conducted to further clarify the long-term (>10 years) results of autologous BM-MNC implantation in patients with TAO.Methods and Results:An observational study was conducted of the long-term results of BM-MNC implantation in 47 lower limbs of 27 patients with TAO. The mean (±SD) follow-up period was 12.0±8.6 years. There was no major amputation event up to 10 years of follow-up in patients treated with BM-MNC implantation. The overall amputation-free survival rates were significantly higher in patients who underwent BM-MNC implantation than in internal controls and historical controls. There was no significant difference in amputation-free survival rates between the historical and internal controls. There was also no significant difference in overall survival between patients who underwent BM-MNC implantation and the historical controls. CONCLUSIONS BM-MNC transplantation successfully prevented major limb amputation over a period of >10 years in patients with severe TAO who had no other therapeutic options.
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Affiliation(s)
- Farina Mohamad Yusoff
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Yuji Takaeko
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Shinji Kishimoto
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Haruki Hashimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Ayumu Nakashima
- Department of Stem Cell Biology and Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University.,Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
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29
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Abstract
See Article by Le Joncour et al .
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Affiliation(s)
- Jeffrey W Olin
- 1 Zena and Michael A. Wiener Cardiovascular Institute & Marie-Jose'e and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY
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30
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Georgakarakos E, Koutsoumpelis A, Koufopoulos G, Tilkeridis K. Never Underestimate a Concomitant Repairable Inflow Lesion in Buerger's Disease! INT J LOW EXTR WOUND 2019; 18:342-343. [PMID: 31198080 DOI: 10.1177/1534734619854636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of Buerger's disease is presented where percutaneous endovascular treatment of a concomitant focal stenosis in the superficial femoral artery led to immediate remission of symptoms and aided wound healing. The existence of such lesions should never be underestimated.
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Affiliation(s)
- Efstratios Georgakarakos
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | - Konstantinos Tilkeridis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,University Hospital of Alexandroupolis, Alexandroupolis, Greece
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31
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Le Joncour A, Soudet S, Dupont A, Espitia O, Koskas F, Cluzel P, Hatron PY, Emmerich J, Cacoub P, Resche‐Rigon M, Lambert M, Saadoun D. Long-Term Outcome and Prognostic Factors of Complications in Thromboangiitis Obliterans (Buerger's Disease): A Multicenter Study of 224 Patients. J Am Heart Assoc 2018; 7:e010677. [PMID: 30571594 PMCID: PMC6405548 DOI: 10.1161/jaha.118.010677] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/08/2018] [Indexed: 01/04/2023]
Abstract
Background Data regarding long-term outcome of patients with thromboangiitis obliterans are lacking and most series come from India and Japan. In this study, we assess long-term outcome and prognostic factors in a large cohort of thromboangiitis obliterans. Methods and Results Retrospective multicenter study of characteristics and outcomes of 224 thromboangiitis obliterans patients fulfilling Papa's criteria were analyzed. Factors associated with vascular events and amputations were identified. The median age at diagnosis was 38.5 (32-46) years, 51 (23.8%) patients were female, and 81.7% were whites. After a mean follow-up of 5.7 years, vascular events were observed in 58.9%, amputations in 21.4%, and death in 1.4%. The 5-, 10-, and 15-year vascular event-free survival and amputation-free survival were 41% and 85%, 23% and 74%, and 19% and 66%, respectively. Ethnic group (nonwhite) (hazard ratio 2.35 [1.30-4.27] P=0.005) and limb infection at diagnosis (hazard ratio 3.29 [1.02-10.6] P=0.045) were independent factors of vascular event-free survival. Factor associated with amputation was limb infection (hazard ratio 12.1 [3.5-42.1], P<0.001). Patients who stopped their tobacco consumption had lower risk of amputation ( P=0.001) than those who continued. Conclusions This nationwide study shows that 34% of thromboangiitis obliterans patients will experience an amputation within 15 years from diagnosis. We identified high-risk patients for vascular complications and amputations.
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Affiliation(s)
- Alexandre Le Joncour
- UPMC Univ Paris 06UMR 7211, and Inflammation‐Immunopathology‐Biotherapy Department (DHU i2B)Sorbonne UniversitésParisFrance
- UMR_S 959INSERMParisFrance
- Department of Internal Medicine and Clinical ImmunologyAP‐HPGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
- Centre national de référence des maladies Autoimmunes Systémiques raresCentre National de Référence Des Maladies Autoinflammatoires et de l'AmyloseFrance
| | - Simon Soudet
- Département de Médecine Interne et Immunologie CliniqueCHU LilleLilleFrance
- Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (Sclérodermie)France
| | - Axelle Dupont
- Service de Biostatistique et Information médicaleAPHPHôpital Saint‐LouisParisFrance
| | | | - Fabien Koskas
- Service de chirurgie vasculaireGroupe Hospitalier Pitié‐SalpétrièreParisFrance
| | - Philippe Cluzel
- Service d'Imagerie CardiovasculaireInstitut de cardiologieGroupe Hospitalier Pitié‐SalpétrièreParisFrance
| | - Pierre Yves Hatron
- Département de Médecine Interne et Immunologie CliniqueCHU LilleLilleFrance
- Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (Sclérodermie)France
| | - Joseph Emmerich
- Department of Vascular Medicine and CardiologyUniversity Hospital Hotel DieuUniversity Paris‐DescartesParisFrance
| | - Patrice Cacoub
- UPMC Univ Paris 06UMR 7211, and Inflammation‐Immunopathology‐Biotherapy Department (DHU i2B)Sorbonne UniversitésParisFrance
- UMR_S 959INSERMParisFrance
- Department of Internal Medicine and Clinical ImmunologyAP‐HPGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
- Centre national de référence des maladies Autoimmunes Systémiques raresCentre National de Référence Des Maladies Autoinflammatoires et de l'AmyloseFrance
| | | | - Marc Lambert
- Département de Médecine Interne et Immunologie CliniqueCHU LilleLilleFrance
- Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (Sclérodermie)France
| | - David Saadoun
- UPMC Univ Paris 06UMR 7211, and Inflammation‐Immunopathology‐Biotherapy Department (DHU i2B)Sorbonne UniversitésParisFrance
- UMR_S 959INSERMParisFrance
- Department of Internal Medicine and Clinical ImmunologyAP‐HPGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
- Centre national de référence des maladies Autoimmunes Systémiques raresCentre National de Référence Des Maladies Autoinflammatoires et de l'AmyloseFrance
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