Applications of Artificial Intelligence in Non-cardiac Vascular Diseases: A Bibliographic Analysis

Research output related to artificial intelligence (AI) in vascular diseases has been poorly investigated. The aim of this study was to evaluate scientific publications on AI in non-cardiac vascular diseases. A systematic literature search was conducted using the PubMed database and a combination of keywords and focused on three main vascular diseases (carotid, aortic and peripheral artery diseases). Original articles written in English and published between January 1995 and December 2020 were included. Data extracted included the date of publication, the journal, the identity, number, affiliated country of authors, the topics of research, and the fields of AI. Among 171 articles included, the three most productive countries were USA, China, and United Kingdom. The fields developed within AI included: machine learning (n = 90; 45.0%), vision (n = 45; 22.5%), robotics (n = 42; 21.0%), expert system (n = 15; 7.5%), and natural language processing (n = 8; 4.0%). The applications were mainly new tools for: the treatment (n = 52; 29.1%), prognosis (n = 45; 25.1%), the diagnosis and classification of vascular diseases (n = 38; 21.2%), and imaging segmentation (n = 38; 21.2%). By identifying the main techniques and applications, this study also pointed to the current limitations and may help to better foresee future applications for clinical practice.

Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries

Peripheral artery diseases are a worldwide medical and social problem. Approximately 30 % of patients with critical limb ischemia will undergo amputations and 25 % will die after 1 year. These patients require reconstructive and angioplastic interventions to preserve the limb. The aim of the study is to compare the effectiveness of different endovascular surgical technologies in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries. Materials and methods. Among 243 endovascular interventions, 51 patients were presented with multilevel steno-occlusive lesions of the infrarenal aortic arteries as a result of atherosclerosis obliterans. 42 patients (82.4 %) had two-level lesions and 9 (17.6 %) had three-level lesions. Results. Among 42 patients with a two-level lesion, 29 (56.9 %) ones had femoral arterial segment affection in combination with tibial artery affection. 13 (25.5 %) patients suffered from the lesion of the iliac segment in combination with the affection of the femoral segment arteries. In 9 (17.6 %) patients the lesions of three or more levels were determined: an iliac segment in combination with femoral and popliteal arteries – in 4 patients, and in 2 patients there were lesions of the femoral, popliteal and tibial segments, in 3 patients there was a lesion of the iliac, femoral, popliteal and tibial-foot segments in different degrees of severity. 7 balloon angioplasties and 13 stenting procedures were performed in two and three-level lesions in which the iliac arterial segment was affected. Only balloon angioplasty was used to revascularize the infraingvinal arterial segments. In the early postoperative period, the complications included thrombosis appeared in 6 patients. It was possible to restore the blood flow and save the limb only in 3 persons. For the other 3 ones, the attempts to restore the patency of the arteries were unsuccessful and resulted in the amputation of the lower extremity. Mortality in the early postoperative period was 3.9 % (2 death due to myocardial infarction). Conclusions. The persons with multilevel steno-obstructive lesions of the infrarenal aortic arteries are the most difficult category of patients with CLI. The surgical method of choice for patients with multilevel steno-occlusive lesions is the endovascular angioplasty with or without stenting.

Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism

Background Degenerative aortic arch aneurysms are known to develop through a pathological process of arterial atherosclerosis, which could be accompanied by peripheral artery diseases and resultant development of intrapelvic collateral arteries to the ischemic lower limbs. The aim of this study was to investigate the relationship between peripheral collateral circulation and postoperative paraplegia after total arch repair with a frozen elephant trunk in patients with degenerative aortic arch aneurysms and peripheral artery diseases. Methods Between October 2014 and March 2020, 27 patients (20 men; 69.8 ± 7.7 years old) underwent total arch repair with a frozen elephant trunk. Two of the 27 patients developed paraplegia postoperatively. The patients were divided into two groups, spinal cord ischemia (SCI) group (2 patients) and no-SCI group (25 patients). The aortic shagginess score, arterial calcification (subclavian artery; hypogastric artery) score, and the number of hypogastric artery branches, assessed using preoperative contrast-enhanced computed tomography images, were compared between the two groups. Results The ankle brachial artery pressure index (i.e., lower side value each patient) was lower in the SCI group than that in the no-SCI group (0.64, 0.71, and 1.09±0.07, respectively). There was no difference between the two groups in the arterial calcification scores or the aortic shagginess score. The number of hypogastric artery branches was greater in the SCI group than in the no-SCI group (66, 66, and 30.7±7.5, respectively). Conclusions Enhanced collateral circulation to the ischemic lower limbs in patients with combination of degenerative aortic arch aneurysms and peripheral artery diseases may be involved in paraplegia the upper thoracic spinal cord injury after total arch repair with a frozen elephant trunk.

Achieving Hemostasis Posttranscatheter Aortic Valve Replacement in a Patient with Aortobifemoral Bypass Graft Using Perclose Device: A Novel Technique

The presence of aortobifemoral bypass graft can complicate vascular access during percutaneous intervention. Choosing an access route for transcatheter aortic valve replacement (TAVR) in this patient population can be challenging. Access options are further limited by the presence of coexisting vascular comorbidities such as extensive peripheral artery diseases in these patients. Adequate preoperative planning to determine the suitability of different access sites is, therefore, very crucial. Our case report shows that the use of Perclose can be a viable option for achieving hemostasis after a direct puncture of an aortobifemoral bypass graft during transfemoral TAVR.

Monitoring of risk factors of cardiovascular diseases in adult men

The study aims to evaluate the monitoring of risk factors of cardiovascular diseases in the young population, which significantly contribute to the origin and development of cardiovascular diseases, such as peripheral artery diseases, atherosclerosis, stroke, and others. We focused on a group of young adult men (n = 110) in the age range of 30 to 50 years, which we selected from the database of 800 patients hospitalized in the Cardio Center in Nitra during 2010 – 2020. When evaluating the influence of meat products consumption frequency on biochemical parameters and BMI, we recorded a statistically significant effect at the level of p <0.05 in the evaluation of meat products such as salami, brawn, and sausages. When consuming sausages, BMI values also increased with increasing frequency of consumption. The effect on BMI was also observed when eating salami, between consuming 1 – 2 times a week and not at all. We recorded a statistically significant effect (p <0.05) in frequent consumption of brawn (1 – 2 weeks) on the level of HDL cholesterol. The most frequent fish consumption was 1 – 2 times a month for freshwater (51.8%) and marine fish (56.3%). Daily consumption of fruit was reported in 64.6% of men, while daily consumption of vegetables was recorded in only 44.6% of men. In the lifestyle assessment, we focused on probands' time spent on physical activity. Only 35.5% of men stated that they spend more than an hour a day on physical activity. 40% of men from the surveyed respondents were active smokers. Another risk factor for cardiovascular diseases is stress, which significantly affected up to 42.7% of respondents. Nutrition and lifestyle play an important role in the prevention of cardiovascular diseases, which significantly affect blood lipid parameters, vascular endothelial elasticity, and factors determining the etiopathogenesis of cardiovascular diseases.

Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.

Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.

Up and down waves of glycemic control and lower-extremity amputation in diabetes

Lower extremity amputations (LEA) are associated with a high mortality and medical expenditure. Diabetes accounts for 45% to 70% of LEA and is one of the most potent risk factors for peripheral artery diseases (PAD). The existence of a link between the recent relaxation of glycemic targets and the resurgence of LEA is suggested from the analysis of adult participants in the National Health and Nutrition Examination Survey (NHANES) between 2010 and 2015, when diabetes-related LEA increased by more than 25% associated with a decline in glycemic control. Indeed, in “the perfect wave” of NHANES, including the years 2007–2010, there was the highest number of diabetic people with hemoglobin A1c (HbA1c), non-high-density lipoprotein (HDL) cholesterol and blood pressure levels at their respective targets, associated with the lowest number of LEA. Until now, the ACCORD study, testing the role of aggressive vs conventional glucose control, and the LEADER trial, evaluating the effects of liraglutide versus placebo, have shown a reduced incidence of LEA in people with type 2 diabetes. The results of ongoing clinical trials involving glucagon-like peptide-1 receptor agonists (GLP-1RA, liraglutide or semaglutide) hopefully will tell us whether the wider use of these drugs may provide additional vascular benefits for diabetic people affected by PAD to decrease their risk of LEA.

Features of Antithrombotic Therapy in Patients with Multifocal Arterial Disease

Multifocal arterial injury is common in patients with atherosclerotic cardiovascular diseases and is associated with increased risk of cardiovascular complications and death. Administration of more intensive antithrombotic therapy, particularly combinations of acetylsalicylic acid and a “vascular” dose of rivaroxaban, in patients with multifocal arterial injury is characterized by a beneficial ratio of efficiency and safety due to a pronounced decrease in the risk of cardiovascular complications. Detection of peripheral artery diseases in patients with ischemic heart disease and atherosclerotic cerebrovascular pathology makes it possible to improve the risk stratification, optimize the diagnostic tactics and clarify indications for more intensive antithrombotic therapy.