Summary:Background: Thoracic endovascular aortic repair (TEVAR) is a well-established technique for the management of blunt thoracic aortic injury (BTAI). Despite improvements in vascular imaging, graft material properties, and implant techniques, stent-graft deployment artificially induces aortic stiffening. This study aimed to evaluate the midterm effect of thoracic endovascular aortic repair after blunt thoracic aortic injury on aortic stiffness and cardiac function in young patients using cardiovascular magnetic resonance (CMR) imaging. Patients and methods: From all patients who underwent TEVAR for BTAI between 2009 and 2019 in a single institution, 10 patients with no other comorbidities affecting arterial stiffness were sex-, age-, height-, and body surface area-matched to 10 healthy controls. Comprehensive CMR examination was performed in all controls and patients. The mean follow-up period was 5.4±1.8 years; the mean age at the time of TEVAR was 30.3±8.7 years. Results: Four patients who underwent TEVAR developed arterial hypertension. 4D flow CMR-based analysis demonstrated higher global pulse wave velocity (PWV) in TEVAR patients than in controls (p=0.012). Segmental analysis showed a higher PWV in the descending and abdominal aorta. The indexed diameter of the ascending aorta was larger in TEVAR patients than in controls (p=0.007). The CINE acquisitions demonstrated increased left ventricular myocardial thickness (p<0.001). The 3D global diastolic strain rate and diastolic longitudinal velocity (e′) decreased, and the A-wave velocity increased. Native myocardial T1 values were significantly higher in TEVAR patients (p=0.037). Conclusions: Young patients with TEVAR after BTAI are at an increased risk of developing vascular and myocardial dysfunction due to increased aortic stiffness. CMR follow-up allows for a comprehensive and radiation-free evaluation of vascular stiffness and associated myocardial changes, especially at the early and subclinical stages.

Summary: The new guidelines for the management of peripheral arterial and aortic diseases (PAAD) from the European Society of Cardiology and endorsed by the European Society of Vascular Medicine (ESVM), emphasize on a comprehensive and multidisciplinary approach focusing on prevention, diagnosis, treatment, and follow-up of patients with a wide range of PAAD, including lower extremity peripheral arterial disease (PAD). The aim of this summary, focusing on PAD and coordinated by the Young Academy of ESVM, is to provide young angiologists with the fundamental principles of these guidelines and to assist them in navigating their everyday clinical practice. PAD diagnosis relies on objective evaluation of flow/oxygen reduction at rest, with arterial ultrasound as the first imaging modality to confirm the presence of arterial lesions. The main goals of PAD management are not only to improve functioning and prevent the occurrence of adverse events at the lower limb level, but also to reduce the overall atherosclerotic burden and achieve the general well-being of patients. To this end, traditional and nontraditional cardiovascular risk factors need to be properly addressed through lifestyle changes and tailored drug therapies. For patients with exertional limb symptoms, supervised exercise training is recommended. Interventional treatment is indicated for limb salvage in patients with chronic limb threatening ischemia and may also be discussed in a multidisciplinary setting in less severe patients with persisting symptoms and reduced quality of life after a minimum period of optimal medical treatment including exercise therapy. For trainees or young specialists in Angiology/Vascular Medicine, these guidelines provide essential elements to improve patient management, encourage interdisciplinary collaboration, and ensure an integrated approach to vascular diseases.

Background: The ankle-brachial index (ABI) is a popular method for evaluating peripheral artery disease (PAD). However, it is unreliable in patients with diabetes mellitus (DM), particularly in cases of media arterial calcification (MAC), where falsely elevated or unreliable values may be produced. The toe-brachial index (TBI) is therefore recommended in such cases, but has its limitations. The tissue optical perfusion pressure (TOPP) method is another automated diagnostic protocol combining oscillometric ABI measurement (oABI) and photo-plethysmographic pulse-wave assessment using the pulse wave index (PWI). The study evaluated TOPP-derived parameters in diabetic patients with or without MAC, in comparison with established functional vascular examinations. Methods: PAD patients with DM presenting in our outpatient clinic were enrolled prospectively from January to August 2024. Patients with peripheral bypasses or deemed unsuitable for the TOPP method were excluded. All patients received an ABI, TBI and TOPP measurement. Results: A total of 107 patients with DM were included in the present study. 38 patients presented with MAC and 69 patients without. The majority were male. Most patients presented with claudication (20 Fontaine stage IIa, 30 stage IIb), 9 presented with rest pain (Fontaine stage III), and 31 with wounds (Fontaine stage IV). 17 patients were free of symptoms (Fontaine stage I). The two parameters of the TOPP method, oABI and PWI, both correlated with the TBI and ABI. In patients with MAC, the oABI did not correlate with any other measurement, but the PWI did weakly correlate with the TBI. MAC is an important factor in influencing measurement accuracy. Despite their limitations, the TBI showed a significant correlation to the clinical symptoms (correlation coefficient = −0.387, p < 0.001). Conclusions: In patients without MAC, oABI and PWI correlated with ABI and TBI. TBI was the most reliable parameter in those with MAC. PWI correlated with TBI, but the correlation was weak. TBI should not be replaced by PWI. PWI may provide complementary information in a diagnostic protocol. oABI did not correlate with clinical symptom severity in DM patients, independently of the presence of MAC, and is unsuitable as a stand-alone parameter. A combination of TBI and TOPP-derived parameters may help to assess the severity of peripheral artery disease in diabetic patients with MAC. Larger multicentre studies are required.

Summary: Background: Vascular medicine/angiology plays a crucial role in managing vascular diseases, yet its recognition, training, and practice vary across Europe. To understand these disparities, the European Society for Vascular Medicine (ESVM) conducted a survey among young trainees to assess their attitudes and perception towards vascular medicine training. Methods: A cross-sectional survey was distributed among trainees and young specialists from European countries, including nations with and without vascular medicine as a recognized specialty. The survey was published on the ESVM website and shared through national vascular medicine societies. Participants provided insights into their training experiences, opinions of the specialty, and priorities for improvement. Statistical analysis compared responses based on specialty recognition. Findings: Among 210 respondents, 36.2% (n=76) were from countries without formal specialty recognition. Training was more structured in countries with a recognized specialty (p<.001). Multidisciplinary team meetings were deemed critical by 98.1% but were more common in countries with a recognized specialty (p=.003). Overall, 80.5% (n=169) expressed interest in training abroad. Core vascular domains were well-covered, while areas like lymphatic and microvascular diseases lacked sufficient training both in countries where the specialty was recognized and where it was not. Respondents from countries with a recognized specialty rated their training significantly higher (p=.001). Despite challenges, 85.2% (n=179) would choose the specialty again, and 90.4% (n=190) supported a unified European certification. Interpretation: These findings highlight the need for a harmonized training framework in Europe ensuring a shared foundational curriculum in vascular medicine while enhancing professional mobility and improving patient care across the whole spectrum of vascular diseases.