Delaying PTA of borderline stenoses is safe using this watch-and-wait strategy and stenoses remain stable over at least short time, but with higher risk of progression especially after prior PTA. We believe that the definition of precise criteria of stenosis significance is necessary for the benefit of ultrasound surveillance.

BackgroundIdiopathic inflammatory myopathies (IIM) are associated with systemic inflammation, limited mobility, and glucocorticoid therapy, all of which can lead to metabolism disturbances, atherogenesis, and increased cardiovascular (CV) risk. The aim of this study was to assess the CV risk in IIM patients and healthy controls (HC), and its association with disease-specific features.MethodsThirty nine patients with IIM (32 females; mean age 56; mean disease duration 4.8 years; dermatomyositis: n = 16, polymyositis: n = 7, immune-mediated necrotizing myopathy: n = 8, anti-synthetase syndrome: n = 8) and 39 age-/sex-matched HC (32 females, mean age 56) without rheumatic diseases were included. In both groups, subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded. Muscle involvement, disease activity, and tissue damage were evaluated (Manual Muscle Test-8, Myositis Intention to Treat Activity Index, Myositis Damage Index). Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (by densitometry and bioelectric impedance). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE, charts for the European population) and its modifications.ResultsCompared to HC, there was no significant difference in IIM patients regarding blood pressure, ABI, PWV, CIMT, and the risk of fatal CV events by SCORE or SCORE2, or subclinical atherosclerosis (CIMT, carotid plaques, ABI, and PWV). The calculated CV risk scores by SCORE, SCORE2, and SCORE multiplied by the coefficient 1.5 (mSCORE) were reclassified according to the results of carotid plaque presence and CIMT; however, none of them was demonstrated to be significantly more accurate. Other significant predictors of CV risk in IIM patients included age, disease duration and activity, systemic inflammation, lipid profile, lean body mass, and blood pressure.ConclusionsNo significant differences in CV risk factors between our IIM patients and HC were observed. However, in IIM, CV risk was associated with age, disease duration, duration of glucocorticoid therapy, lipid profile, and body composition. None of the currently available scoring tools (SCORE, SCORE2, mSCORE) used in this study seems more accurate in estimating CV risk in IIM.

Background: The patency of arteriovenous grafts (AVG) for hemodialysis is mostly limited by growing stenoses that lead to decreasing of blood flow, thromboses and finally to access failure. The aim of this study was to find out if detection of any pathology by duplex Doppler ultrasonography (DDU) early after creation of AVG could identify those with lower survival. Methods: We retrospectively enrolled AVG examined by DDU in our center within 40 days after their creation during the last 10 years. The findings were divided into 4 subgroups: (1a) normal finding, (1b) DDU risk factor (low flow volume, medial calcinosis of the feeding artery, presence of intimal hyperplasia in the venous anastomosis), (2a) non-significant or (2b) significant stenosis. The primary outcome measure was the cumulative survival of people with AVGs, and the secondary was the primary (unassisted) survival. All patients underwent DDU surveillance every 3 months with pre-emptive treatment of significant stenoses. Results: Overall, 340 cases were found; the median follow-up was 565 days. Normal DDU finding had 60% cases, DDU risk factor 18% cases, non-significant stenosis 13% cases and significant stenosis 9% cases. Occurrence of early significant stenosis was associated with high risk of access loss (hazards ratio (HR) 14.73; 95% CI 5.10-42.58; p < 0.0001). Similarly, the presence of a DDU risk factor and of a non-significant stenosis were related to significantly shorter access lifespan (HR 2.86; 95% CI 1.10-7.40; p = 0.03 and HR 2.83; 95% CI 1.12-7.17; p = 0.03, respectively). Conclusion: DDU examination of AVG early after their creation can identify those at higher risk and may contribute to individualize the surveillance strategy.

screening. Cost-effectiveness becomes more favorable overtime. Repeat screening of patients whose initial scan result is normal is not justified.Summary: The United Kingdom Multicentre Aneurysm Screening Study (MASS) has provided most of the randomized evidence for mortality benefit for AAA screening (Cochrane Database Syst Rev 2007;CD002945) The authors sought to answer some remaining questions concerning AAA screening, including longer-term benefits of mortality and cost-effectiveness, and whether rescreening after a normal scan result is indicated. The data presented are from the randomized MASS trial with 10 years of follow-up. Data were acquired in four centers in the United Kingdom, with screening and surveillance delivered primarily in primary care centers. The population sample included 67,770 men aged 65 to 70 years. Participants in the original MASS study were allocated to ultrasound screening or to a control group not offered screening. When an AAA was detected, the participants underwent surveillance and were offered surgery if they met prespecified criteria. Main outcome measures have been mortality and costs related to AAA repair and cost per life-year gained.There were 155 deaths related to AAA over 10 years in the group invited for screening (absolute risk, 0.46%) and 296 deaths related to AAA in the control group (0.87%). Relative risk reduction was 45% (95% confidence interval [CI], 37%-57%). The benefits seen in the early years of follow-up were maintained in later years. Incremental cost per man invited to screening was £100 (95% CI, £82-£118), with an incremental cost-effectiveness ratio of £7,600 (95% CI, £5,100-£13,000) per life-year gained. The incidence of ruptured AAA in patients with an originally normal screening result increased after 8 years. Total mortality at 10 years was about 30% in each group, with AAAs comprising about 2% of all deaths. There was no clear difference in any other cause of death, with only a small difference in all-cause mortality (hazard risk, 0.97, 95% CI, 0.95-1.00).There were 25 ruptures that occurred after men had normal initial scan results and 19 were fatal. Rate of ruptures increased noticeably after 8 years of follow-up. Time since initial scan rather than age was the main determinant of the increased risk of rupture.Comment: AAA screening appears to be effective in reducing AAArelated deaths out to 10 years after the initial screening examination. A crucial question is whether rescreening participants is justified at any stage. The authors contend that rescreening is not justified because the number of fatal ruptures occurring after 8 years in the screened group was relatively small. Additional follow-up will be required to determine if there is a noticeable increase in ruptures in the screened group that is not sufficiently offset by the reduction in number of deaths related to the original aortic aneurysm screening.

Coronary artery disease negatively influences the cumulative patency of vascular access. Higher serum cholesterol levels are associated with lower AVG failure risk over a 1000-day period, which probably corresponds to the worse disease status of the patients with lower cholesterol values.