Background: The COVID-19 pandemic developed its full destructive capacity in 2020. This retrospective study aimed to examine the effects of COVID-19 on the mortality and the clinical characteristics in PAD patients with COVID-19 compared to PAD patients without COVID-19. Methods and results: Data derived from a German nationwide register of the year 2020 which encompassed all hospitalized patients with PAD ( n = 173.075); N = 2553 also suffered from a COVID-19 infection and had significantly higher mortality rates of 11.2%. PAD + COVID-19 patients presented more clinical complications like major amputations (11.59%), myocardial infarction (2.08%), cardiogenic shock (2.98%), chronic kidney failure with GFR<= 15 mL/min (5.33%) and prolonged ventilation time >48 h (3.37%). Rates of pulmonary thromboembolism (0.24%), myocardial infarction (2.08%), and stroke (1.02%) were low in patients with PAD + COVID-19. Adjusted regression analyses for risk differences revealed possible causes of higher mortality rates, such as prolonged ventilation time, pneumonia, major amputations, multiple organ system failure, and length of hospital stay in patients with severe PAD (Rutherford 5-6) + COVID-19. Conclusion: Pneumonia and major amputations were associated with high mortality rates in PAD + COVID-19 in 2020. However, we could not detect a relevant influence of pulmonary thromboembolism, myocardial infarction or stroke on higher death rates of PAD + COVID-19.

Summary: Background: Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. Patients and methods: This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA₂DS₂-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA₂DS₂-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86–0.87) but had the worst calibration for high-risk patients. The CHA₂DS₂-VA Score had the lowest AUC 0.69 (95% CI: 0.68–0.70) but was the most consistent prediction model regarding calibration. Conclusions: HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA₂DS₂-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA₂DS₂-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.

Summary: Background: Symptomatic peripheral arterial disease (PAD) is difficult to non-invasively diagnose in the presence of calcified, media sclerotic arteries that are incompressible by blood pressure cuffs. Standard ankle-brachial index (ABI) measurements in these PAD patients are very often not helpful. Shear wave elastography (SWE) is a modern ultrasound technique to detect peripheral muscle stiffness changes i.e. muscle weakness during exercise. In a pilot study, we examined whether SWE could be a reproducible tool for diagnosing ischemic loss of muscle stiffness in patients with PAD and concomitant arterial media sclerosis. Patients and methods: N=13 consecutive patients with peripheral artery disease and media sclerosis were enrolled in the pilot study. All 13 patients were symptomatic in different stages of their PAD due to hemodynamically relevant arterial stenosis or occlusions of limb arteries as confirmed by oscillography, color-coded duplex sonography or angiography. Results: ABI measurements were invalid in all 13 patients. Mean SWE measurements of medial gastrocnemius muscles showed a significant transient muscle stiffness loss (weakness) at maximum exercise (active dorsal flexion of the foot, 103.4±25.9 kPa on the asymptomatic vs. 62.5±21.9 kPa on the symptomatic limb (p<0.001). Conclusions: SWE can reproducibly detect peripheral muscle weakness during exercise in the symptomatic leg of media sclerotic PAD patients. SWE of lower limb muscles may help to identify symptomatic PAD in patients presenting with invalid ABI measurements and unclear vascular status.

This study aimed to evaluate the acute treatment of patients with severe aortic valve stenosis in Germany. Three treatment strategies in 11,027 patients acutely admitted due to aortic valve stenosis were compared from 2014 until 2018 using German nationwide records: The annual number of transcatheter aortic valve replacement (TAVR) procedures (1,294 to 1,827) and balloon valvuloplasty (BV only) procedures (170 to 233) in patients acutely admitted increased, but surgical aortic valve replacement (SAVR) procedures decreased (426 to 316). In comparison to BV only patients (mean age 81.3; EuroSCORE 23.2) SAVR patients were younger and at lower logistic EuroSCORE (mean age 66.9; EuroSCORE 9.4). Patients treated with TAVR were at comparable age and operative risk (mean age 81.3; EuroSCORE 24.4) as those patients treated with BV only. Primary outcome was in-hospital mortality. Reimbursement was considered secondary outcome. After risk adjustment using multivariable logistic and linear regression analyses, SAVR (OR 0.26 [96%CI 0.16;0.45], p < 0.001) and TAVR (OR 0.38 [0.29;0.49], p < 0.001) were associated with lower risk for mortality compared to BV only. Compared to BV only, hospitalization costs of patients undergoing SAVR were reduced by €5,578 ([95%CI €8,023; €3,133], p < 0.001). TAVR procedures were associated with higher hospitalization costs than BV only (risk-adjusted difference €4,143 [€2,330; €5,926], p < 0.001). BV only was associated with a substantially increased risk of in-hospital mortality in acute patients. We conclude that a definitive aortic valve replacement should be preferred as primary treatment in patients with severe aortic valve stenosis causing an acute admission.

Radial artery occlusion (RAO) after transradial PCI is the most common vascular complication. While prior studies highlight sheath size, sheath-to-artery ratio and hemostasis technique, radial tortuosity and a dominant ulnar artery have been less explored. Evaluate post-procedural vascular ultrasound-defined anatomical features linked to established, symptomatic RAO and describe reperfusion outcomes. In a single-center observational cohort, 103 post-PCI patients underwent vascular ultrasound (51 RAO, 52 controls). Measured variables included radial/ulnar diameters, tortuosity and high brachial bifurcation. Multivariable logistic regression with Firth correction identified independent associated factors. Follow-up vascular ultrasound was available in a subset. Dominant ulnar artery (≥0.24 cm and larger than the radial) was independently associated with RAO (OR 8.0, p = 0.02), as was radial tortuosity (OR 4.0, p = 0.03). Prior ipsilateral radial access carried a strong association (OR = 15) but was insignificant (p = 0.06). The final model showed excellent discrimination (AUC 0.93). At follow-up (n = 26), most RAO cases remained occluded despite anticoagulation; only two patients demonstrated late reperfusion at 5-6 months. Post-procedural vascular ultrasound demonstrated that dominant ulnar perfusion and radial tortuosity were strongly associated with symptomatic RAO. While causality cannot be inferred, these findings generate hypotheses that selected anatomical patterns may be associated with increased susceptibility and warrant prospective validation. A "vascular ultrasound-first" strategy warrants evaluation prospectively to preserve radial patency.