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May-Thurner syndrome (MTS) results from a frequent anatomic variant in which compression of the left common iliac vein between the body of the fifth lumbar vertebra and the pulsating right common iliac artery can cause deep venous thrombosis (DVT) of the left lower limb. While anticoagulation remains the mainstay treatment of acute DVT, catheter-directed thrombolysis combined with stenting provides a safe and effective method for relieving acute symptoms and preventing postthrombotic syndrome in patients with MTS. In this article the diagnostic and treatment methods are presented in the case report of a 65-year-old woman with MTS who suffered iliofemoral DVT. Knowledge of anatomy is crucial for understanding and recognizing MTS as well as for treating MTS with endovascular procedures.

The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4–6 weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.

Abstract. Background: The role of genetic polymorphisms in peripheral arterial disease (PAD) is incompletely understood. We tested whether selected single nucleotide polymorphisms (SNPs) were associated with PAD and with adverse events in an observational study cohort. Also, the role of diabetes and smoking was studied. Patients and methods: 742 patients with PAD and 713 age- and gender-matched control subjects were subjected to yearly physical and laboratory investigations and were managed for 5 years according to the European guidelines on cardiovascular disease prevention. The occurrence of all-cause death, cardiovascular death, non-fatal myocardial infarction, ischemic stroke or critical limb ischemia (major events) and revascularization procedures (minor events) was recorded. In 655 patients with PAD and 612 control subjects the following SNPs were determined: rs1466408, rs13428968 and rs12803 of NR4A2 gene, rs10499563 of IL6 gene, rs668 and rs12953 of PECAM1 gene, and rs10861032 of Chr12 locus. Results: The distribution of selected SNPs did not differ between patients with PAD and control subjects, and neither between subjects with or without major adverse events. In contrast, diabetes and smoking affected survival and event-free survival. Among patients with PAD, diabetes doubled the hazard ratio (HR) for cardiovascular death and smoking doubled the HR for death or major event. The 5-year survival of diabetics with PAD was 0.80 (CI 0.75–0.85) and of non-diabetics with PAD 0.87 (CI 0.84–0.90), p = 0.045. The 5-year survival of active smokers with PA D was 0.80 (CI 0.75–0.62), of former smokers 0.83 (CI 0.79–0.88), and of never-smokers 0.89 (CI 0.86–0.93), p = 0.024. Conclusions: SNPs of NR4A2, IL6, PECAM1 and Chr12 were not associated with PAD or with major adverse events. However, diabetes and smoking were associated with worse survival and event-free survival in patients with PAD.

Abstract. Background: Percutaneous endovascular revascularisation interventions are increasingly used in treatment of lower extremity artery disease and may expose patients to substantial radiation. Patients and methods: Dose-area product (DAP) was retrospectively analysed in 1063 consecutive interventions performed in adult patients with lower extremity artery disease in a single tertiary medical centre. Differences between procedure types, stratified according to anatomical region and arterial lesion complexity were evaluated. Results: Median DAP for diagnostic interventions was 35.6 (15.0–52.4) Gy cm2 in aorto-below-knee arteriography and 3.2 (2.0–4.5) Gy cm2 in ipsilateral femoral arteriography (p < 0.001). For angioplasty without stenting, median DAP was 53.4 (28.6–87.4) Gy cm2 for pelvic interventions vs. 5.9 (4.3–8.6) Gy cm2 for antegrade ipsilateral femoropopliteal interventions (p < 0.001). For stenting, median DAP was 54.9 (32.5–91.2) Gy cm2 for pelvic interventions vs. 8.3 (6.0–12.3) Gy cm2 for antegrade ipsilateral femoropopliteal interventions (p < 0.001). Inside the same anatomical region, diagnostic interventions were associated with significantly lower DAP than therapeutic interventions. Stenting vs no stenting increased DAP values only in antegrade ipsilateral femoropopliteal interventions (8.3 (6.0–12.3) vs 5.9 (4.3–8.6) Gy cm2 (p < 0.001). Arterial lesion complexity affected DAP values only in antegrade ipsilateral femoropopliteal therapeutic interventions. Conclusions: The most important factor influencing patients’ radiation doses was the anatomical region. Pelvic interventions were associated with 6–11-times higher DAP values than femoropopliteal interventions with antegrade ipsilateral approach. Stenting and complexity of lesions increased DAP only in antegrade ipsilateral femoropopliteal interventions.