There are limited data on the arterial stiffness changes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The present study evaluated the changes in arterial stiffness in completely healthy patients who had a SARS-CoV-2 infection using the cardio‐ankle vascular index (CAVI). The study included 70 patients with SARS-CoV-2 infection between December 2020 and June 2021. A cardiac evaluation was carried out, including chest X-ray, electrocardiography (ECG), and echocardiography in all patients. Within the 1st month and 7th month CAVI was measured. Mean age was 37.8 ± 10.0 years, and 41/70 were female. Mean height was 168.6 ± 9.5 cm, mean weight 73.2 ± 15.1 kg, and mean body mass index (BMI) of the group was 25.6 ± 4.2, respectively. CAVI results from the right arm were 6.45 ± .95 at 1-month follow-up and 6.68 ± 1.05 at 7 months follow-up (P = .016) and from the left arm were 6.43 ± 1.0 at 1-month follow-up, 6.70 ± 1.05 at 7-month follow-up (P = .005). Our results showed an ongoing injury in the arterial system after healthy SARS-COV-2 patients during 7 months, as represented by CAVI measurements.

Aim: To investigate the impact of direct and indirect revascularization, based on the angiosome concept, on major amputation, minor amputation, and wound healing outcomes after endovascular intervention in patients with critical limb ischemia.Material and Methods: A total of 121 patients with critical limb ischemia and foot ulcer (Rutherford stage 5–6) were evaluated. During follow-up, 3 patients died, and successful revascularization could not be achieved in 29 patients. The remaining 89 patients were classified according to successful restoration of blood flow to the affected angiosome as direct revascularization (DR, n=59) or indirect revascularization (IR, n=30). Patients were followed for three months for major amputation, minor amputation, and wound healing outcomes.Results: Among 89 successfully revascularized patients (mean age 63.9 ± 10.2 years, 81.6% male), direct angiosome-targeted flow was achieved in 59 patients (66.3%). During follow-up, the DR group had a significantly lower major amputation rate compared to the IR group (10.2% vs 30%, p=0.018). Minor amputation rates were similar between groups (23.7% vs 23.3%, p=0.967), while wound healing was significantly better in the DR group (61% vs 36.7%, p=0.030).Conclusion: Angiosome-guided direct revascularization may reduce major amputation risk and improve wound healing in isolated below-knee lesions. Whenever feasible, direct revascularization should be considered the preferred treatment strategy.

Objective: Patients with a history of coronary artery bypass grafting (CABG) often present with advanced age, comorbidities, and diffuse atherosclerosis, making coronary angiography more complex. While the transfemoral route has been traditionally preferred, transradial access has emerged as a safer and more comfortable alternative. Recently, transulnar access has also gained interest, especially when radial access is not feasible. To compare the efficacy and safety of transulnar versus transradial access in CABG patients undergoing coronary angiography.Method: In this retrospective, single-center study, 37 post-CABG patients who underwent coronary angiography between 2022 and 2024 via left radial (n=18) or left ulnar (n=19) access were evaluated. Baseline demographics, risk factors, laboratory data, procedural parameters, and complications were analyzed. All procedures were performed with 6 Fr catheters.Results: The groups were comparable in terms of demographics, risk factors, and laboratory findings. There were no significant differences in procedure time, fluoroscopy duration, radiation dose, or catheter use. However, puncture time was significantly shorter in the transradial group (15.8 ± 8 vs. 28.2 ± 17 min, p=0.007). No major complications occurred in either group. Femoral crossover was more frequent in the transulnar group, though not statistically significant (21.1% vs. 0%, p=0.059).Conclusions: Transulnar access is a safe and effective alternative to transradial Access in CABG patients undergoing coronary angiography. While puncture time was longer in the transulnar group, overall procedural success and safety were comparable. Transulnar access may be especially useful when radial access is limited

Background: Endothelial dysfunction and chronic low-grade inflammation have been implicated in the pathophysiology of restless legs syndrome (RLS). The Endothelial Activation and Stress Index (EASIX), a composite biomarker calculated from serum lactate dehydrogenase, creatinine, and platelet count, reflects endothelial activation and systemic biological stress. However, its association with RLS has not previously been investigated. Objective: To compare EASIX levels between patients with RLS and healthy controls and to evaluate the relationship between EASIX and disease severity. Methods: This retrospective case–control study included 199 patients diagnosed with RLS according to the International Restless Legs Syndrome Study Group criteria and 190 healthy controls. Demographic, clinical, and laboratory data were collected retrospectively. EASIX was calculated as LDH (U/L) × creatinine (mg/dL) / platelet count (10⁹/L). Correlations between EASIX and disease duration, disease stage, and International Restless Legs Syndrome Rating Scale (IRLS) scores were assessed using Spearman’s correlation analysis. To account for the potential confounding effect of age, analysis of covariance (ANCOVA) was performed with age as a covariate. Results: Patients with RLS had significantly higher unadjusted EASIX levels than healthy controls (0,520 ± 0,228 vs. 0,465 ± 0,159, p = 0.005). Serum lactate dehydrogenase, urea, WBC, Neutrophil and EASİX levels were also significantly higher, whereas serum iron levels were significantly lower in the RLS group. EASIX demonstrated weak but significant positive correlations with IRLS score ( r = 0.167, p = 0.018), disease stage ( r = 0.180, p = 0.011), and disease duration ( r = 0.198, p = 0.005). However, after adjustment for age, the difference in EASIX between the RLS and control groups was no longer statistically significant ( p = 0.490). In multivariable logistic regression analysis, EASIX was not independently associated with RLS (OR = 1.202, 95% CI: 0.621–2.328, p = 0.585). Conclusions: EASIX levels were higher in patients with RLS than in healthy controls in the unadjusted analysis; however, this difference was no longer statistically significant after adjustment for age, and EASIX was not independently associated with RLS in multivariable analysis. Although weak correlations with disease severity and duration were observed in unadjusted analyses, these associations were not significant after age adjustment. These findings should therefore be considered exploratory and hypothesis-generating. The diagnostic, severity-related, and prognostic utility of EASIX as a biomarker in RLS remains to be established in prospective, longitudinal, and externally validated studies. Clinical trial number: Not applicable.

Objectives: Radial artery spasm (RAS) is a common complication of transradial coronary angiography that may adversely affect procedural success and patient comfort. This study aimed to evaluate clinical, procedural, and anthropometric factors associated with RAS in patients undergoing elective transradial coronary angiography, with a particular focus on the wrist circumference-to-body mass index (WC/BMI) ratio as a novel predictor. Methods: A total of 466 patients who underwent elective coronary angiography via the right radial artery between January 2024 and December 2024 were included. All procedures were performed using a 6 Fr introducer sheath according to a standardized protocol. Radial artery spasm was clinically defined as operator resistance during catheter manipulation accompanied by patient-reported pain or marked discomfort in the accessed arm. Wrist circumference and body mass index were measured before the procedure, and the WC/BMI ratio was calculated. Radial artery diameter was assessed using ultrasonography. Variables associated with RAS were evaluated using univariable and multivariable logistic regression analyses. Due to collinearity between WC/BMI and radial artery diameter, two separate multivariable models were constructed. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Radial artery spasm occurred in 51 patients (10.9%). Patients who developed RAS had significantly lower WC/BMI ratios and smaller radial artery diameters compared with those without spasm (both p ≤ 0.001). In multivariable analysis, a lower WC/BMI ratio was independently associated with an increased risk of RAS (odds ratio [OR] 0.51 per 0.1-unit increase; 95% confidence interval [CI] 0.34–0.78; p = 0.002). Similarly, smaller radial artery diameter remained an independent predictor of RAS (OR 0.83 per 0.1 mm increase; 95% CI 0.75–0.92; p < 0.001). The area under the curve (AUC) was 0.651 for WC/BMI and 0.636 for radial artery diameter. The combined model demonstrated improved discriminative ability (AUC 0.713). Conclusions: The WC/BMI ratio is a simple, practical, and readily obtainable anthropometric parameter that can predict the risk of radial artery spasm before transradial coronary angiography. When combined with radial artery diameter, it provides improved discrimination for identifying patients at higher risk of RAS.

Objectives: This study presents our experience with prilocaine-induced methemoglobinemia in patients undergoing permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) implantation. Methodology: We conducted a retrospective analysis of patients who developed clinically significant methemoglobinemia following PPM or ICD implantation between 2019 and 2023. Results: Out of 651 patients who underwent PPM or ICD implantation, 19 patients developed methemoglobinemia after prilocaine administration and were included in the analysis. Of these, 68.4% (13 patients) were female, with a mean age of 75.1 ± 10.1 years, indicating a predominantly elderly population. Regarding comorbidities, 16 patients had hypertension, 10 had diabetes mellitus, 7 had coronary artery disease, and 5 had congestive heart failure. A dual-chamber pacemaker was implanted in 12 patients, a single-chamber pacemaker in 3, a dual-chamber ICD in 2, and a single-chamber ICD in 2. The mean haemoglobin level was 11.5 ± 1.3 g/dL, with 13 patients (68.4%) presenting with anaemia. Mean serum albumin was 32.8 ± 3.7 g/dL, with hypoalbuminemia observed in 9 patients (47.4%). The mean glomerular filtration rate was 67.0 ± 23.3 mL/min/1.73 m², and 15 patients (78.9%) had reduced renal function. The average oxygen saturation among those who developed methemoglobinemia was 87.1 ± 2.0%. The mean MetHb level prior to treatment was 10.2 ± 3.9%, which significantly decreased to 1.9 ± 0.5% following treatment (p < 0.001). Conclusion: Clinicians should consider the possibility of methemoglobinemia in patients with unexplained low oxygen saturation that is inconsistent with their clinical presentation. Prompt administration of methylene blue in patients with comorbidities can lead to rapid clinical improvement.