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Peripheral Circulation

Position papers and consensus documents from the ESC Working Group on Peripheral Circulation



The year in cardiology 2015: peripheral circulation

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Published in the European Heart Journal in January 2016; ehv709
DOI: 10.1093/eurheartj/ehv709

Authors: , , , , , , , on behalf of the ESC Working Group on Peripheral Circulation

Preamble: In 2015, the interest of carotid intima-media thickness to reclassify individual risk is challenged, but this vascular marker could remain interesting for younger subjects. In a middle-aged Spanish cohort, the coexistence of several peripheral plaques is frequent, with the ilio-femoral plaques having the best correlation with coronary calcium. Regarding asymptomatic carotid stenosis (ACS), multi-modality imaging presents increasing interest to depict those requiring revascularization.

The role of vascular biomarkers for primary and secondary prevention

A position paper from the ESC Working group on peripheral circulation

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Published in the Atherosclerosis Journal in August 2015; 241(2):507-32; Epub 2015 May 16
DOI: 10.1016/j.atherosclerosis.2015.05.007

Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society

Authors: Charalambos Vlachopoulos (Chairperson), Panagiotis Xaplanteris, Victor Aboyans, Marianne Brodmann, Renata Cífková, Francesco Cosentino, Marco De Carlo, Augusto Gallino, Ulf Landmesser, Stéphane Laurent, John Lekakis, Dimitri P. Mikhailidis, Katerina K. Naka, Athanasios D. Protogerou, Damiano Rizzoni, Arno Schmidt-Trucksäss, Luc Van Bortel, Thomas Weber, Akira Yamashina, Reuven Zimlichman

Highlights:

  • Risk scores are used in clinical decision-making but can under- or overestimate risk.
  • Biomarkers can further stratify the risk of patients at an individual level.
  • Biomarkers may prevent the occurrence of clinical disease by timely treatment.
  • Nine criteria should be met for a biomarker to be a surrogate endpoint.
  • Carotid ultrasonography, ABI and cfPWV fulfill most of the criteria.

The year in cardiology 2014: peripheral circulation

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Published in the European Heart Journal in Mar 2015 ;36(10):591-7; Epub 2015 January 3
DOI: 10.1093/eurheartj/ehu515

Authors: Victor Aboyans, Marianne Brodmann, Marco De Carlo, Denis Clement, Lucia Mazzolai, Lucas van Bortel, Marc R.H. van Sambeek, Charalambos Vlachopoulos

Abstract: In 2014, the debate on the indication of revascularization in case of asymptomatic carotid disease continued, while another one regarding the use of surgery vs. stenting addressed some new issues regarding the long-term cardiac risk of these patients. Renal arteries interventions trials were disappointing, as neither renal denervation nor renal artery stenting was found associated with better blood pressure management or outcome. In contrast, in lower-extremities artery disease, the endovascular techniques represent in 2014 major alternatives to surgery, even in distal arteries, with new insights regarding the interest of drug-eluting balloons. Regarding the aorta, the ESC published its first guidelines document on the entire vessel, emphasizing on the role of every cardiologist for screening abdominal aorta aneurysm during echocardiography. Among vascular wall biomarkers, the aorta stiffness is of increasing interest with new data and meta-analysis confirming its ability to stratify risk, whereas carotid intima-media thickness showed poor performances in terms of reclassifying patients into risk categories beyond risk scores. Regarding the veins, new data suggest the interest of D-dimers and residual venous thrombosis to help the decision of anti-coagulation prolongation or discontinuation after the initial period of treatment for deep vein thrombosis.

Non-coronary atherosclerosis

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Published in the European Heart Journal in May 2014; 35(17):1112-9; Epub 2014 March 4
DOI: 10.1093/eurheartj/ehu071

Authors: Augusto Gallino, Victor Aboyans, Curt Diehm, Francesco Cosentino, Hans Stricker, Erling Falk, Olaf Schouten, John Lekakis, Beatrice Amann-Vesti, Francesco Siclari, Pavel Poredos, Salvatore Novo, Marianne Brodmann, Karl-Ludwig Schulte, Charalambos Vlachopoulos, Raffaele De Caterina, Peter Libby, Iris Baumgartner

Abstract: During the last decades, the clinical and research interest in atherosclerosis has been mostly focused on coronary arteries. After the publications of the European Society Guidelines and AHA/ACC Guidelines on Peripheral artery diseases, and of the Registry REduction in Atherothrombosis for Continued Health Registry, there has been an increased interest in atherosclerosis of the lower extremity arteries and its presence in multifocal disease. However, awareness in the general population and the medical community of non-coronary artery diseases, and of its major prognostic implications remain relatively low. The aim of this general review stemming out of an ESC Working Group on Peripheral Circulation meeting in 2011 is to enhance awareness of this complex disease highlighting the importance of the involvement of atherosclerosis at different levels with respect to clinical presentation, diagnosis, and co-existence of the disease in the distinct arterial territories. We also emphasize the need of an interdisciplinary approach to face the broad and complex spectrum of multifocal disease, and try to propose a series of tentative recommendations and measures to be implemented in non-coronary atherosclerosis.

Methods for evaluating endothelial function

A position statement from the European Society of Cardiology Working Group on Peripheral Circulation

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Published in the European Journal of Cardiovascular Prevention & Rehabilitation; 0(00) 1–15; Epub 2011 January 4th
DOI: 10.1177/1741826711398179

Authors: J Lekakis, P Abraham, A Balbarini, A Blann, C M Boulanger, J Cockcroft, F Cosentino, J Deanfield, A Gallino, I Ikonomidis, D Kremastinos, U Landmesser, A Protogerou, C Stefanadis, D Tousoulis, G Vassalli, H Vink, N Werner, I Wilkinson and CVlachopoulos.

Summary: This paper presents in vivo and ex vivo methods for evaluating endothelial function with special focus on more recent ones. Insights and practical informations on the theoretical basis, methodological aspects and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention.