The new immunosuppressive agent FK778 attenuates neointima formation in an experimental venous bypass graft model.

Neointima formation as a result of smooth muscle cell (SMC) proliferation still contributes significantly to venous bypass graft stenosis and failure. The new immunosuppressive agent FK778 has recently been shown to exert anti-proliferative effects. We examined the inhibitory potential of FK778 on venous SMC proliferation and neointima formation in an experimental venous bypass graft model.

Noninvasive diagnosis of ruptured peripheral atherosclerotic lesions and myocardial infarction by antibody profiling.

Novel biomarkers, such as circulating (auto)antibody signatures, may improve early detection and treatment of ruptured atherosclerotic lesions and accompanying cardiovascular events, such as myocardial infarction. Using a phage-display library derived from cDNAs preferentially expressed in ruptured peripheral human atherosclerotic plaques, we performed serological antigen selection to isolate displayed cDNA products specifically interacting with antibodies in sera from patients with proven ruptured peripheral atherosclerotic lesions. Two cDNA products were subsequently evaluated on a validation series of patients with peripheral atherosclerotic lesions, healthy controls, and patients with coronary artery disease at different stages.

Multicenter randomized controlled trial of the costs and effects of noninvasive diagnostic imaging in patients with peripheral arterial disease: the DIPAD trial.

Objective: The purpose of our study was to compare the costs and effects of three noninvasive imaging tests as the initial imaging test in the diagnostic workup of patients with peripheral arterial disease.

Materials And Methods: Of 984 patients assessed for eligibility, 514 patients with peripheral arterial disease were randomized to MR angiography (MRA) or duplex sonography in three hospitals and to MRA or CT angiography (CTA) in one hospital. The outcome measures included the clinical utility, functional patient outcomes, quality of life, and actual diagnostic and therapeutic costs related to the initial imaging test during 6 months of follow-up.

Synergistic effect of Toll-like receptor 4 and CD14 polymorphisms on the total atherosclerosis burden in patients with peripheral arterial disease.

Background: Genes involved in the regulation of immune responses, such as Toll-like receptor 4 (TLR4) and CD14, show genetic variations with potential functional implications. Because atherosclerosis is an inflammatory process apparently modulated by chronic infections, we studied the effect of single nucleotide polymorphisms (SNPs) in TLR4 and CD14 on the extent of clinically relevant atherosclerosis in patients with peripheral arterial disease (PAD).

Methods: Using an in-house-developed polymerase chain reaction-based restriction length polymorphism assay, we determined the genotype, allele frequency, and carrier traits of the TLR4 +896 A>G and the CD14 -260 C>T SNPs in 607 white Dutch patients with PAD.

Human heat shock protein 60 stimulates vascular smooth muscle cell proliferation through Toll-like receptors 2 and 4.

Heat shock proteins (HSPs) of endogenous and exogenous origin are suspected contributors to the initiation and aggravation of vascular pathologies like atherosclerosis and restenosis. Toll-like receptors (TLRs) 2 and 4 are well-known receptors for exogenous pathogen-associated molecular patterns and have recently been thought to play a role in HSP60-induced cellular activation. We hypothesized that human HSP60 directly stimulates venous smooth muscle cell (VSMC) proliferation through a TLR-dependent mechanism.

Diagnosis of abdominal aortic hypoplasia by state-of-the-art MR angiography.

Abdominal aortic hypoplasia is a rare vascular variant with possible major clinical sequelae when the renal arteries are also involved. The condition is thought to result from embryonic overfusion of the two dorsal aortas. The diagnosis may be considered in patients presenting with hypertension in the neonatal period and severely reduced or absent arterial pulses in the groin.

The effect of flow changes on the arterial system proximal to an arteriovenous fistula for hemodialysis.

Arterial remodeling in response to flow changes is controlled by the endothelium, sensing wall shear stress (SS) changes. The present study focuses on the remodeling capacities of the brachial (BA) and radial artery (RA) of 16 renal failure patients after arteriovenous fistula creation. Pre- and postoperatively at predetermined time-points, diameter, wall thickness and peak and mean SS were assessed.

C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events.

Background: Serum C-reactive protein (CRP) has proven to be an independent marker of the extent of atherosclerosis in patients with coronary, cerebrovascular, and peripheral arterial disease. In this prospective observational study, we wanted to assess the relationship between serum CRP and extent of disease transversely and longitudinally in time, as well as future cardiovascular complications in patients with peripheral arterial disease (PAD). Hypothesizing that CRP not only is a marker of but also actively participates in atherogenesis, we explored the possibility of CRP production by femoral atherosclerotic plaques.

Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis.

Purpose: To prospectively compare the diagnostic accuracies of color duplex ultrasonography (US) and contrast material-enhanced magnetic resonance (MR) angiography and to assess interobserver agreement regarding contrast-enhanced MR angiographic findings in patients suspected of having peripheral arterial disease (PAD).

Materials And Methods: The institutional review board approved the study, and all patients provided signed informed consent. Two hundred ninety-five patients referred for diagnostic and preinterventional work-up of PAD with duplex US also underwent gadolinium-enhanced MR angiography.

Endothelin-1 levels and conduit artery mechanical properties in end-stage renal disease.

Background: Endothelial cell (EC) dysfunction markers are increased in end-stage renal disease (ESRD). The present study focused on the relationship between EC markers, conduit artery wall mechanics and hemodynamics in ESRD.

Methods: In 29 ESRD patients and 16 controls, brachial artery diameter, distension, and wall thickness was measured and circumferential wall stress (CWS) calculated.

Comparison of contrast-enhanced magnetic resonance angiography and digital subtraction angiography in patients with chronic critical ischemia and tissue loss.

Rationale And Objectives: To compare the ability of intra-arterial digital subtraction angiography (IA-DSA) and total runoff contrast-enhanced magnetic resonance angiography (CE-MRA) to demonstrate peripheral arterial anatomy, specifically in patients with chronic critical ischemia and tissue loss.

Materials And Methods: Twenty-three consecutive patients with chronic critical ischemia and tissue loss underwent CE-MRA and IA-DSA within 2 days. Two teams, consisting of an interventional radiologist and vascular surgeon who were blinded to each other's results, determined the number of named arteries (21 segments) and the presence of >/=50% stenosis or occlusion.

Vasculin, a novel vascular protein differentially expressed in human atherogenesis.

Recent suppressive subtractive hybridization analysis on human atherosclerotic plaque-derived RNA revealed genes upregulated in plaques with a thrombus versus stable plaques. Clone SSH6, containing part of a putative open reading frame of an unknown protein, was further investigated. Full-length cDNA, coding for a 473-amino acid (aa) protein, was identified in a vascular smooth muscle cell (SMC) cDNA library.

Comparison of treatment plans for peripheral arterial disease made with multi-station contrast medium-enhanced magnetic resonance angiography and duplex ultrasound scanning.

Objective: This study was undertaken to investigate the effects of substituting multi-station total outflow contrast medium-enhanced magnetic resonance angiography (CE-MRA) for color duplex ultrasound (US) scanning on treatment planning in the diagnostic workup of patients with suspected or known peripheral arterial occlusive disease. Patients and methods One hundred consecutive patients referred because of suspected or proved peripheral arterial occlusive disease to a University Hospital underwent both aortoiliac duplex US scanning and multi-station total outflow CE-MRA. For 73 of these patients (57% men; mean age, 62 years) treatment or treatment plans could be retraced.

Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies.

The acute compartment syndrome is caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone. It is characterized by increased intracompartmental pressure and decreased tissue perfusion. Well-known causative incidents are acute trauma and reperfusion after treatment for acute arterial obstruction.

Chlamydia pneumoniae serology: comparing a commercial enzyme immunoassay and microimmunofluorescence test in patients with cardiovascular disease.

Chlamydia pneumoniae has been associated with cardiovascular disease and the detection of C. pneumoniae antibodies has subsequently challenged many cardiovascular investigators. The micro-immunofluoresence (MIF) test is considered the gold standard for detection of C.

Prosthetic femorocrural bypass surgery and adjuvant arteriovenous fistulae.

The use of an adjuvant arteriovenous fistula (AVF) in vascular procedures is controversial. The purpose of this study was to evaluate our experience with this adjunct in femorodistal bypass surgery. Patients who received a prosthetic femorocrural bypass with or without an AVF were studied (n = 56).

Serum C-reactive protein level is associated with abdominal aortic aneurysm size and may be produced by aneurysmal tissue.

Background: Abdominal aortic aneurysms (AAA) are characterized by extensive transmural inflammation and C-reactive protein (CRP) has emerged as an independent risk factor for the development of cardiovascular disease. Therefore, we evaluated a possible association between serum CRP and aneurysm dimension in patients with asymptomatic AAA. Furthermore, the possibility of CRP production by aneurysmal tissue has been examined.

Hemodynamics of venous cuff interposition in prosthetic arteriovenous fistulas for hemodialysis.

Purpose: The durability of prosthetic arteriovenous fistulas (AVF) for hemodialysis is jeopardized by thrombotic occlusions due to intimal hyperplastic stenoses. In arterial reconstructive surgery, peripheral arterial bypasses with prosthetic material benefit from a venous cuff at the distal anastomosis. Therefore, a study was performed to assess the effect of a venous cuff at the venous anastomosis of PTFE graft AVFs in terms of stenosis development, hemodynamics and patency rates.

Shear stress depends on vascular territory: comparison between common carotid and brachial artery.

Shear stress (SS) is thought to be constant throughout the vascular system. Evidence for this supposition is scarce, however. To verify this hypothesis in vivo, we assessed common carotid (CCA) and brachial artery (BA) peak and mean wall shear rate (SR) noninvasively in 10 healthy volunteers (23.

Brachial artery shear stress is independent of gender or age and does not modify vessel wall mechanical properties.

The objective of the present study was to obtain brachial artery (BA) baseline shear stress (SS) values in healthy volunteers and to relate this to gender and age. Peak and mean wall shear rate (SR) were noninvasively measured in 30 healthy subjects using an SR estimation system. Arterial diameter and wall characteristics were obtained with a wall tracking system.

Chlamydia pneumoniae serology is associated with thrombosis-related but not with plaque-related microembolization during carotid endarterectomy.

Background And Purpose: Chlamydia pneumoniae has repeatedly been associated with atherosclerotic disease. Our study was designed to clarify whether this association is based on C pneumoniae-induced transformation of a stable into an unstable atherosclerotic plaque or on stimulation of hypercoagulability leading to increased thrombotic arterial occlusions by C pneumoniae infection. Transcranial Doppler ultrasonographic monitoring of the middle cerebral artery during carotid endarterectomy offers the opportunity to study, before removal of the plaque, atherothrombotic emboli dislodging from an unstable carotid plaque (plaque-related emboli) and emboli related to (excessive) thrombus formation at the endarterectomy site after removal of the plaque and restoration of flow (thrombosis-related emboli).