The escalating population of individuals afflicted with end-stage renal disease necessitates the provision of secure and efficacious vascular access for hemodialysis, with arteriovenous fistulas representing a preferred option. Nonetheless, the creation of dialysis fistulas may entail complications, including the occurrence of fistula aneurysms that may require surgical intervention. This study included eight patients with large aneurysms of dialysis fistulas and aimed to evaluate the safety and effectiveness of classic, endovascular, or hybrid methods for fistula reconstruction or ligation, depending on the indications. Vascular interventions were performed on patients on chronic hemodialysis and on those in whom hemodialysis was discontinued due to the proper functioning of the transplanted kidney. Performed procedures were considered safe and effective. The reconstructed fistulas provided the patients with patent vascular access, allowing for continued hemodialysis. No re-aneurysmal dilatation of the reconstructed or ligated fistulas was observed. Regular monitoring of dialysis fistulas is crucial to detect complications in time. Guidelines should be established to specify the dimensions at which fistula aneurysm should be excised and whether to remove asymptomatic aneurysms at all. For patients who have undergone kidney transplantation, outlines should indicate when the fistula should be preserved and when it should be ligated.

Background: Published reports demonstrate that the use of Castor stent-graft is a promising treatment of aortic pathologies with the need to land in zone 2. However, there is a lack of publications on the medium-term results of Castor in the European population. This research evaluates the mid-term results of the Castor stent-graft in several Polish centers for the treatment of aortic pathologies and enriches the current knowledge of Castor stent-grafts. Material and methods: Twenty-one patients from 5 polish vascular surgery centers in subacute phase of type B aortic dissection (TBAD) with at least 1 classic risk factor of aneurysmatic degeneration, thoracic aortic aneurysms (TAAs) exceeding 5.5 cm, subacute phase of intramural hematomas (IMHs) and penetrating aortic ulcerations (PAUs) with at least 1 indication to endovascular treatment. Structure of the aortic arch and factors of aneurysmal degeneration for TBAD were highlighted. Early complications, long-term complications, and reinterventions after Castor device implantation are reported in the study. Results: Twenty (95.24%) patients survived, of which a technical success involving implantation of the Castor device in the correct location with a patent branch for the left subclavian artery, and no endoleaks were noted in 19 (90.48%) patients. After the procedure, there were 2 (9.52%) cases of type I endoleak (in which technical success was not achieved) and 2 (9.52%) cases of bird beak. In addition, 1 case of access site hematoma, 1 case of pseudoaneurysm, and 1 case of access iliac artery rupture requiring implantation of a Viabahn device were observed. During the follow-up period (mean 14 months; range = 1-40 months), 1 patient required reintervention due to type I endoleak and 1 patient due to left subclavian artery (LSA) branch thrombosis. Two patients required subsequent branched endovascular aortic repair procedure due to unfavorable remodeling and fast aneurysm formation in visceral aorta, regardless of Castor results. Conclusion: The Castor device is an easy-to-use stent-graft with good medium-term results. It is an excellent option in cases requiring LSA revascularization during TEVAR. Clinical Impact: In this study, we investigate the medium-term results of the Castor stent graft in patients with type B aortic dissection, thoracic aortic aneurysm, intramural hematoma and penetrating aortic ulceration. The medium-term results of treatment with the Castor device are not yet well studied. Currently, there are only a small number of publications on the safety, complications and success of Castor device implantation.

The aim of our study was to evaluate the importance of insulin-like growth-factor-binding protein 7 (IGFBP-7) as a potential marker of symptomatic peripheral artery disease (PAD) occurrence. The study group consisted of 145 patients with diagnosed PAD, who qualified for the invasive treatment. The control group consisted of 67 individuals representing the local population and an ischemic heart disease (IHD) group of 88 patients after myocardial infarction or percutaneous coronary intervention. Patients with PAD had significantly higher IGFBP-7 concentrations than control group (1.80 ± 1.62 vs. 1.41 ± 0.45 ng/mL, p = 0.04). No significant differences between PAD patients and IHD patients were found (1.80 ± 1.62 vs. 1.76 ± 1.04 ng/mL, p = 0.783). Patients with multilevel PAD presented significantly higher IGFBP-7 concentrations than patients with aortoiliac PAD—median 1.18 (IQR 0.48–2.23) vs. 1.42 ng/mL (0.71–2.63), p = 0.035. In the group of patients who died or had a major adverse cardiovascular event (MACE) during six months of follow-up, a statistically significant higher IGFBP-7 concentration was found (median 2.66 (IQR 1.80–4.93) vs. 1.36 ng/mL (IQR 0.65–2.34), p = 0.004). It seems that IGFBP-7 is elevated in patients with atherosclerotic lesions—regardless of their locations. Further research should be conducted to verify IGFBP-7 usefulness as a predictor of MACE or death.

Background: The identification of clinical factors affecting the gray-scale median (GSM) and determination of GSM diagnostic utility for differentiating between symptomatic and asymptomatic internal carotid artery (ICA) stenosis. Methods: This study included 45 patients with asymptomatic and 40 patients with symptomatic ICA stenosis undergoing carotid endarterectomy (CEA). Echolucency of carotid plaque was determined using computerized techniques for the GSM analysis. Study groups were compared in terms of clinical risk factors, coexisting comorbidities, and used pharmacotherapy. Results: Mean GSM values in the symptomatic group were significantly lower than in the asymptomatic group (p < 0.001). Both in the univariate as well as in the multiple regression analysis, GSM was significantly correlated with D-dimers and fasting plasma glucose levels and tended to correlate with β-adrenoceptor antagonist use in the symptomatic group. In asymptomatic patients, GSM was associated with the presence of grade 2 and grade 3 hypertension, and tended to correlate with the use of metformin, sulfonylureas, and statin. Independent factors for GSM in this group remained as grade 3 hypertension and statin’s therapy. The receiver operating characteristic (ROC) analysis revealed that GSM differentiated symptomatic from asymptomatic ICA stenosis with sensitivity and specificity of 73% and 80%, respectively. Conclusion: The completely diverse clinical parameters may affect GSM in symptomatic and asymptomatic patients undergoing CEA, whose clinical characteristics were similar in terms of most of the compared parameters. GSM may be a clinically useful parameter for differentiating between symptomatic and asymptomatic ICA stenosis.

Atherosclerosis is a major contributor to ischemic stroke. Carotid plaque instability is a critical determinant of cerebrovascular events, yet its identification remains challenging. One chemokine with well-documented proatherogenic properties is MCP-1, whose levels are elevated in patients with conditions such as hypertension, obesity, and atherosclerosis. This study evaluated the association between obesity, serum MCP-1 levels, and carotid plaque instability as determined by ultrasound gray-scale median (GSM) analysis in 77 patients who underwent carotid endarterectomy. Patients were classified by body mass index. Serum MCP-1 concentrations were measured using the enzyme-linked immunosorbent assay technique. Analyses were performed to explore relationships between clinical parameters, biochemical markers, and plaque stability. Increasing body weight was paralleled by higher MCP-1 levels and lower GSM values, indicative of unstable plaques. Moreover, logistic regression analysis identified MCP-1 as one of the independent predictors of plaque instability, particularly in overweight and hypertensive patients. These results indicate the potential usefulness of MCP-1 as a biomarker of carotid plaque instability, confirming the negative effect of obesity in promoting other known cardiovascular risk factors causing plaque instability in patients with carotid atherosclerosis.

Introduction: Peripheral arterial disease is a chronic condition and a major public health concern. Risk factors of PAD include poor dietary habits, low physical activity levels, smoking tobacco and coexisting diseases like hypertension, diabetes or hyperlipidemia. The goal of the study was to evaluate the influence of dietary habits, physical activity and selected quality-of-life factors on PAD among patients hospitalized at the Department of Vascular Surgery and Transplantation, Medical University of Białystok. Methods: The study was conducted on 127 patients diagnosed with PAD. Standardized questionnaires were used: IPAQ (short version) to assess physical activity, FFQ-6 to evaluate of the quality of diet and SF-36 to evaluate health-related quality of life. Results: A positive correlation between the educational level and diet quality was found—higher education associated with a greater proportion of high-quality products in diet (p = 0.001). A negative correlation was found between age and physical activity level (p < 0.001). Physical activity level was associated with differences in the SF-36 physical component summary, with statistically significant differences observed between the categories of activity (p = 0.047). The positive influence of vitamin supplements on the SF-36 mental component summary was not found; patients taking vitamin supplements had worse MCS results. On top of that, higher physical activity was associated with lower MCS, and longer time spent sitting with higher MCS. Conclusions: The findings suggest that the lifestyle interventions for PAD patients should consider their educational level and the age-related decrease in physical activity. Physical activity remains significantly associated with the physical component of quality of life. Concurrently, the PCS observations suggest that only intensifying physical activity or supplementation is not necessarily associated with the improvement of mental wellbeing. Further analysis that accounts for clinical status and possible confounding factors are warranted.