2024 ESC Guidelines for the management of peripheral arterial and aortic diseases

ZusammenfassungDie im September 2024 veröffentlichten Leitlinien der European Society of Cardiology (ESC) zur peripheren arteriellen Verschlusskrankheit (pAVK) und zu aortalen Erkrankungen bilden erstmals Empfehlungen für beide Krankheitsbilder in einem gemeinsamen Leitliniendokument ab. Die Zusammenführung von pAVK- und Aortenleitlinien folgt einem ganzheitlichen Ansatz, der die Gesamtheit des arteriellen Gefäßsystems unterstreicht. Dieses Ziel wird durch eine eigens eingebrachte Empfehlung unterstrichen, bei Patienten mit Gefäßerkrankungen die Gesamtheit des Kreislaufsystems zu berücksichtigen. Schwerpunkt im aktuellen ESC-Leitlinien-Dokument ist das multidisziplinäre patientenzentrierte Management von pAVK und Aortenerkrankungen, wobei die Prävention und die Nachsorge nach therapeutischen Interventionen hervorgehoben werden. Insbesondere werden bei der pAVK das Gehtraining und das Prozedere bei chronischen Wunden sowie bei Aortenerkrankungen die Risikostratifizierung und hereditäre Aortenerkrankungen behandelt.

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Pre-interventional renal artery calcification and survival after transcatheter aortic valve implantation

Winkler,

Galantay,

Hebeisen

et al. 2024

Int J Cardiovasc Imaging

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The prognostic significance of renal artery calcification (RAC) is unknown in patients with severe aortic stenosis (AS) eligible for transcatheter aortic valve implantation (TAVI). RAC can be assessed by computed tomography (CT) performed during pre-interventional planning for TAVI. This study aimed at investigating the utility of RAC for predicting survival after TAVI. In this longitudinal cohort study, RAC volume was measured by CT in 268 consecutive patients with severe AS undergoing TAVI. Association of RAC with mortality was assessed using Cox regression analysis. RAC was evaluated as a binary parameter and in a supplementary analysis as a logarithmically transformed continuous variable. Over a median follow-up time of 9.6 years, 237 (88.4%) patients died, with 174 (73.4%) deaths attributable to a cardiovascular cause. RAC was highly prevalent (N = 150 (86.2%)) among patients suffering cardiovascular death. Competing risk cumulative incidence curves revealed a higher occurrence of cardiovascular death in patients with RAC (P-value = 0.008), while this was not the case for non-cardiovascular death (P-value = 0.71). RAC was independently associated with cardiovascular death (HR 1.61 [95% CI: 1.01–2.57]; P = 0.047) after adjustment for age, sex, cardiovascular risk factors, impaired renal function, and aortic valve calcification. The presence or absence of RAC rather than its volume was important in all the analyses. RAC is a strong and independent predictor of cardiovascular death in patients with severe AS undergoing TAVI. Given its favourable properties for event prediction, RAC may be considered valuable for prognostic assessment of TAVI patients. Graphical Abstract

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2024 ESC Guidelines for the management of peripheral arterial and aortic diseases

Cited by 37 publications

References 1,573 publications

Prinzipien der endovaskulären arteriellen Intervention

Prinzipien der endovaskulären arteriellen Intervention

Was ist neu im Management der peripheren arteriellen Verschlusskrankheit und der aortalen Erkrankungen?

Pre-interventional renal artery calcification and survival after transcatheter aortic valve implantation

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