Association Between IL-23 And Coronary Arterial Lesions In Children With Kawasaki Disease

The pathogenesis of coronary artery lesions (CALs) in KD patients has been thought of as an unknown stimulus that triggers an inflammatory cascade with activation of the immune system. However, interleukin-23 (IL-23) is supposed as a key cytokine in inflammatory and autoimmunity diseases. The role of IL-23 in the pathogenesis of CALs has not been fully elucidated. This study explored the relationship between the serum IL-23 levels and CALs in patients with KD. We collected blood specimens from 90 children with KD before intravenous immunoglobulin (IVIG) therapy. Levels of IL-23, IL-6, IL-17A, IL-10, MCP-1 and VEGF were measured in 190 cases, including 4 groups: KD with CALs (n = 46), KD without CALs (n = 44), febrile control group, (FC, n = 40) and normal control group, (NC, n = 60). Clinical parameters were tested in all subjects. IL-23 was significantly elevated in the KD group compared with the febrile and normal control groups, especially increased in the KD patients with CALs. Serum levels of IL-23 in KD patients were positively associated with WBC, CRP, IL-6, IL-17A, IL-10, MCP-1, and VEGF in children with KD. IL-23 may be involved in the pro-inflammatory process and the pathogenesis of CALs in KD patients.

Association Between IL-23 and Coronary Arterial Lesions in Children with Kawasaki Disease

The pathogenesis of coronary artery lesions (CALs) in KD patients has been thought of as an unknown stimulus that triggers an inflammatory cascade with activation of the immune system. However, interleukin-23 (IL-23) is supposed as a key cytokine in inflammatory and autoimmunity diseases. The role of IL-23 in the pathogenesis of CALs has not been fully elucidated. This study explored the relationship between the serum IL-23 levels and CALs in patients with KD. We collected blood specimens from 90 children with KD before intravenous immunoglobulin (IVIG) therapy. Levels of IL-23, IL-6, IL-17A, IL-10, MCP-1 and VEGF were measured in 190 cases, including 4 groups: KD with CALs (n = 46), KD without CALs (n = 44), febrile control group, (FC, n = 40) and normal control group, (NC, n = 60). Clinical parameters were tested in all subjects. IL-23 was significantly elevated in the KD group compared with the febrile and normal control groups, especially increased in the KD patients with CALs. Serum levels of IL-23 in KD patients were positively associated with WBC, CRP, IL-6, IL-17A, IL-10, MCP-1, and VEGF in children with KD. In conclusion, IL-23 may be involved in the pro-inflammatory process and the pathogenesis of CALs in KD patients.

Angiographic patterns and temporal changes of arterial lesions in Behcet’s disease

Background Behcet’s disease (BD) can entail vascular involvement in various forms including aneurysm. We evaluated the angiographic patterns and changes in arterial lesions over time in BD patients with arterial involvement. Methods We reviewed the medical records of BD patients diagnosed with arterial lesions between 1995 and 2018. Angiographic patterns were categorized as stenosis, occlusion, dilatation, or aneurysm. Patients were divided according to symptom duration (<5, 5–10, >10 years). Cox proportional-hazards model was used to evaluate the risk factors for vascular progression. Results 47 BD patients had arterial involvement in the following patterns: aneurysm ( n = 31), stenosis ( n = 17), dilatation ( n = 13), and occlusion ( n = 8). Aneurysm (70.8%) was the most common pattern in 24 patients with short (<5 years) symptom duration. Stenosis was more common (50.0%) in 12 patients with longer symptom durations (>10 years). In 23 patients with follow-up imaging (median, 5.7 years), eight (34.8%) developed 11 new lesions: stenosis ( n = 5), dilatation ( n = 1), and aneurysm ( n = 5). One stenotic lesion progressed to occlusion, and two dilated lesions progressed to aneurysms. Lower extremity involvement and methotrexate use were associated with arterial progression, with hazard ratios of 5.716 ( p = 0.029) and 0.101 ( p = 0.049), respectively. Conclusion In BD patients with arterial involvement, aneurysm was the most common pattern in earlier stages of BD, while stenosis was more common in later stages of BD. Methotrexate use was associated with lower risk of arterial lesion progression.

Peripheral arterial disease in patients with renal-diabetic foot ulcers

Objective: To describe the angiographic characteristics of peripheral arterial disease (PAD) in persons with diabetic foot ulcers (DFUs) on dialysis treatment. Method: The study is a retrospective analysis of patients with DFUs and PAD who had been referred to our diabetic foot clinic. All patients had been managed by a pre-set limb salvage protocol including revascularisation of the affected limb. Arterial lesions (stenosis between 50–99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence or not of dialysis, patients were divided into two patient groups: renal-diabetic foot (RDF) and diabetic foot (DF). Distribution of PAD and immediate revascularisation outcome (technical revascularisation outcome) for RDF and DF were separately reported and compared. Results: The sample included 239 patients: mean age was 71.8 years; 72.4% were male; 87.4% had type 2 diabetes; mean diabetes duration was 21.4 years; and the mean HbA1c was 63±22mmol/mol. The RDF group compared with the DF group reported higher numbers of vessels affected (n=5±1.6 versus 3.9±1.5, respectively, p<0.0001), greater involvement of the superficial femoral artery (90.2% versus 75.8%, respectively, p=0.003), the tibial-peroneal trunk (53.7% versus 25.5%, respectively, p=0.01), the anterior tibial artery (93.9% versus 80.9%, respectively, p=0.03) and below-the-ankle (BTA) arteries (70.7% versus 35.7%, respectively, p=0.0001). The RDF group showed a higher rate of revascularisation failure in comparison to DF patients (43.9% versus 15.3%, respectively, p<0.0001). BTA arterial disease (odds ratio 9.5; 95% Confidence Interval: 3.5–25.4; p=0.0001) resulted as the only independent predictor of revascularisation failure. Conclusion: In this study, RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison with DF patients. BTA arterial disease was found to be an independent predictor of revascularisation failure.

Short-term Follow-up of Duplex Guided Angioplasty for Femoropopliteal Arterial Occlusive Disease

Aim: The aim of this study is to evaluate initial and short-term result of duplex guided angioplasty (DGA) for treatment of femoropopliteal arterial lesions. Methods: From October 2017 to September 2020, 50 limbs in 50 patients (30 males) underwent DGA in our institution. The study was conducted on patients suffered from chronic lower limb ischemia of grade IIb, III and IV (according to Fontaine Classifications) resulting from femoropopliteal lesions (occlusion or stenosis). Arterial access was done under duplex guidance followed by advancing a guidewire across the diseased femoropopliteal segment(s). The diseased segment(s) were then balloon-dilated. Intimal dissection or residual stenosis causing diameter reductions greater than 30% were stented with a self-expandable stent under duplex guidance. Completion duplex examinations and ankle brachial indices were obtained after the procedure. Results: The mean age of patients was 64 ±8 years. Critical ischemia was the indication in 44%, and disabling claudication was the indication in 6% of cases. Technical success was achieved in 46 cases (92%). 31 cases (62%) went through transluminal crossing of the lesions using duplex guidance alone, 11 cases (22%) went transluminally using duplex combined with contrast-free fluoroscopic assistance and 4 cases (8%) was subjected to subintimal angioplasty using combined techniques. Stenting was done in 24 cases (48%), 16 cases (32%) were having floating intimal flap; while the other 8 cases (16%) had residual stenosis > 30%. A primary patency rate of 92% was obtained by the end of the 12 months follow-up period. Conclusion: Duplex can be used as a first strategy for the treatment of femoropopliteal arterial diseases. However, the pitfalls in DGA technique make it insufficient to replace the classic fluoroscopy.

Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study

Background The aim of this study was to determine the rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries (PRI). Methods This retrospective cohort study was conducted in a level I trauma center serving 500,000 inhabitants. A total of 127 consecutive patients with high-energy blunt PRI were included between January 1st, 2014 and December 31st, 2017. Every patient had a total body or thoraco-abdominal computed tomography scan including contrast enhanced arterial sequences. A board-certified radiologist reviewed all the vascular images and precisely described every intra-pelvic arterial lesion in terms of localization. Complete pelvic series (standard radiographs and fine cut computed tomography images) were reviewed by three board-certified orthopedic surgeons experienced in PRI management, and Young and Burgess and AO/OTA classifications were determined. Demographic, clinical, therapeutic and outcome data were extracted from the institutional severely injured patients’ registry. Results Patients’ mean age was 45.3 years and 58.3% were males. Fifteen (11.8%) had a total of 21 intra-pelvic arterial lesions: seven lesions of the obturator artery, four of the superior gluteal artery, three of the inferior gluteal artery, two of the vesical artery, and one of each of the following arteries: internal iliac, internal pudendal, fifth lumbar, lateral sacral, ilio-lumbar. These lesions occurred in 8.6% of lateral compression injuries, 33.3% of anteroposterior compression injuries and 23.5% of vertical shear and combined mechanism injuries (Young and Burgess classification, p = 0.003); and in 0% of type A injuries, 9.9% of type B injuries and 35% of type C injuries (AO/OTA classification, p = 0.001). Patients with an intra-pelvic arterial lesion were more likely to present with pre-hospital hemodynamic instability (p = 0.046) and to need packed red blood cells transfusion within the first 24 h (p = 0.023; they needed a mean of 7.53 units vs. 1.88, p = 0.0016); however, they did not have a worst outcome in terms of complications or mortality. Conclusions This systematic study found an 11.8% rate of intra-pelvic arterial lesion related to high-energy blunt PRI. The obturator, superior gluteal and inferior gluteal arteries were most often injured. These findings are important for the aggressive management of high-energy blunt PRI.

POS0802 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY AS A PREDICTOR OF ANGIOGRAPHIC PROGRESSION OF DISEASE IN LARGE-VESSEL VASCULITIS

Background:Giant cell arteritis (GCA) and Takayasu’s arteritis (TAK) are the two main forms of large-vessel vasculitis (LVV). Although angiography is essential to detect vascular disease in patients with LVV, there is limited prospective data characterizing change in arterial lesions over time, and factors that predict angiographic change remain unknown.Objectives:The objectives of this study were to: 1) describe longitudinal change in angiographic studies in patients with GCA and TAK and 2) determine whether FDG-PET activity predicts angiographic progression of disease.Methods:Patients with GCA or TAK were recruited into a prospective, observational cohort. All patients underwent baseline magnetic resonance (MR) or computed tomography (CT) angiography and a follow-up study (same modality) ≥6 months after baseline per a standardized imaging protocol. For patients who had multiple angiograms, the baseline and most recent images were compared. Arterial lesions, defined as stenosis, occlusion, or aneurysm, were evaluated by visual inspection in 4 segments of the aorta and 13 branch arteries by a single reader blinded to clinical status. On follow up angiography, the development of new lesions in these same territories was recorded, and existing lesions were characterized as improved, worsened, or unchanged by visual inspection, with confirmation by an independent reader.All patients underwent FDG-PET on the same date as angiography. Qualitative assessment of FDG uptake was performed in each corresponding arterial territory evaluated by angiography. Active vasculitis was defined as greater FDG uptake in the arterial wall compared to the liver by visual inspection.Results:At the baseline visit, there were 248 arterial lesions (21%) out of 1162 arterial territories evaluated from 70 patients with LVV (TAK=38; GCA=32). Baseline characteristics were as follows: Age [TAK=29.5 years (18.4-39.5), GCA=69.6 years (60.7-75.5)], Female gender [TAK=30 patients (79%), GCA=23 patients (72%)], Disease duration [TAK=2.2 years (0.6-5.5), GCA=0.7 years (0.1-2.6)], Active clinical disease [TAK=17 patients (45%), GCA=20 patients (63%)].Over 1.6 years (1.0-2.7) of median follow-up, no angiographic change was observed in 1,132 (97%) arterial territories. New lesions developed in 8 arterial territories, exclusively in 5 patients with TAK. Arterial lesions improved in 16 territories (GCA = 7, TAK = 9) and worsened in 6 territories (GCA = 1, TAK = 5). Patients with angiographic improvement were initially imaged earlier in the disease course compared to patients with new/worsening lesions (median 1.1 vs 16.4 months, p=0.09). Patients with angiographic improvement had significantly lower acute phase reactants at follow-up compared to patients with new/worsening arterial lesions [median ESR 3.0 (2.0-15.0) vs. 27.0 (7.3-39) mm/h, p<0.01; median CRP 0.7 (0.3-1.4) vs. 6.1 (3.1-19.6) mg/L, p<0.01]. Seventy-nine percent of patients with new/worsening arterial lesions had received increased treatment over the follow-up interval compared to 100% patients with improved arterial lesions, p=0.09.FDG-PET activity was evaluated in 1091/1162 (94%) of corresponding arterial territories. PET activity in an arterial territory at baseline was significantly associated with change in that arterial territory (either new/worsening or improvement) on follow-up angiography (p<0.01) (FIGURE 1). PET activity had a sensitivity of 80% and specificity of 74% for predicting change in arterial lesions. Most arterial territories without PET activity at baseline remained unchanged over time by angiography, yielding a negative predictive value of 99%. (FIGURE 1).Conclusion:Development of new arterial lesions is infrequent in LVV. Change in arterial lesions is dynamic, and improvement can occur. FDG-PET activity predicts change in angiographic lesions, and lack of PET activity is strongly associated with stable angiographic disease. These data may inform guideline recommendations for imaging monitoring in LVV.Figure 1.Disclosure of Interests:None declared

Features of Risk Stratification, Diagnosis and Secondary Prevention in Patients with Multifocal Arterial Disease. Part 2: Treatment Options

The similarity of the pathogenesis of atherosclerosis and atherothrombotic complications, regardless of their location, makes the approaches to secondary prevention similar, which include lifestyle modification, pharmacotherapy of hemodynamic disorders, metabolic changes and hemostasis. Secondary prophylaxis in patients with multifocal arterial lesions using antihypertensive, antithrombotic and lipid-lowering therapy provides a more pronounced decrease in the incidence of cardiovascular complications than in lesions of single vascular lesions due to a higher initial risk. However, these treatments do not reduce the risk to the level that is achieved by treating patients with less atherosclerotic lesion. In this regard, it is of interest to use the currently available new methods and regimens of drug therapy in patients with multifocal arterial lesions, which make it possible to more intensively influence the mechanisms of atherosclerosis progression and more effectively prevent the development of its complications.