Dierk Scheinert

Background: Nutritional deficiencies are associated with poor prognosis in a wide range of illnesses. However, the prognostic impact of poor nutritional status with respect to long-term all-cause mortality in the general non-diseased population is not well described. Objectives: This study sought to report the prevalence, clinical associations, and prognostic consequences of poor nutritional status in a contemporary urban population in Germany. Methods: A cohort of 8398 participants from the LIFE-Adult Study was enrolled. Four objective nutritional scores, the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status Score (CONUT), the Nutritional Risk Index (NRI), and the Triglyceride Cholesterol Body Weight Index (TCBI), were calculated at baseline, and participants’ nutritional status was classified according to score tertiles. The relationship between nutritional status and common risk factors as well as major diseases was assessed. In addition, the association between poor nutritional status at baseline and the risk of all-cause mortality during a seven-year follow-up period was examined. Results: According to the WHO definition of obesity, the LIFE-Adult Study cohort was, on average, overweight, with almost two-thirds of participants (67%) having a BMI ≥ 25 and only 1% being underweight. However, poor nutritional status was not associated with a specific BMI category. Higher age, female sex, cancer, and chronic kidney disease were more common, whereas active smoking and hypercholesterolemia were less prevalent among participants in the lowest PNI tertile (p < 0.01). In the overall population, the cumulative incidence of all-cause mortality was significantly higher among participants in the lowest PNI, NRI, and TCBI tertiles and the highest CONUT category (log-rank test, p < 0.01 for PNI, CONUT, and NRI, and p < 0.04 for TCBI, respectively). After adjustment for confounding factors, the lowest PNI and NRI tertiles and the highest and medium CONUT categories remained independently and significantly associated with an increased risk of all-cause mortality (all p < 0.01) in multivariable Cox regression analyses. TCBI was not associated with all-cause mortality in any regression model. Conclusions: Poor nutritional status is associated with increased mortality in the general population. Clinical trials are needed to prospectively evaluate the efficacy of nutritional interventions on health outcomes.

Background: The objective of this study was to evaluate the long-term safety and efficacy of endovascular therapy (EVT) in complex aortoiliac occlusive disease (AIOD) treated with aortic bifurcation reconstruction using the kissing stent or Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique. Methods: This retrospective single-center study included 201 patients (79.6% ASA stage ≥3) with symptomatic TASC-II C/D AIOD who underwent EVT between 2010 and 2019. Endpoints included technical success and procedural complications. Outcomes assessed over a 5-year follow-up included primary and secondary patency rates, major limb amputation, and survival. Kaplan–Meier (KM) estimates and Cox regression were used for analysis. Results: The cohort had a mean age of 61.9 ± 9.7 years, included 61 female patients (30.3%), and showed a low prevalence of obesity (body mass index >30: 7.5%), while cardiovascular risk factors were highly prevalent, including hypertension in 81.1% and hyperlipidemia in 79.6% of patients. Technical success was achieved in 96.0% (193/201), with 87.1% (175/201) of patients treated with kissing stents and 12.9% (26/201) with the CERAB technique. Overall, major complications were reported in 6.5% (13/201) and access site-related complications in 3.0% (6/201) of cases. Five-year KM estimates were: 72.1% for primary patency, 89.6% for secondary patency, and 79.6% for overall survival. No significant difference in primary patency was observed between techniques (p = 0.55), and one case of major limb amputation was reported after 5 years. Conclusions: EVT using the kissing stent or CERAB technique is a durable and safe treatment for complex AIOD in high-risk patients over 5 years, with favorable outcomes and low periinterventional morbidity and mortality.

Background: In Peripheral Artery Disease (PAD), there is an association between risk factors, the location of atherosclerotic lesions, and outcomes. Methods: This is a retrospective single-center analysis of adult PAD patients admitted between 2018 and 2021 with a follow-up until the end of 2023. Lesions were allocated to “suprainguinal”, “infrainguinal-to-popliteal”, “infrapopliteal”, “two of three levels” and “all three levels” categories based on angiogram findings. The primary endpoint at the patient level was amputation-free survival and was major adverse limb events (MALEs) at the limb level. Results: A total of 2067 patients with 2633 affected limbs were analyzed, and 28.8% were female. At first admission, the median age was 68, and the most frequent PAD Fontaine stage was IIb (44.9%). Lesions were suprainguinal in 11.6%, infrainguinal-to-popliteal in 18.3%, infrapopliteal in 11.4%, two levels in 36.0%, and all three levels in 8.3%. Over 1020 days as the median follow-up, amputation-free survival was 67.6%, highest (92.5%) for suprainguinal lesions, and lowest (59.3%) for infrapopliteal lesions. At the patient level, the risk of major amputation or death was highest in infrapopliteal lesions and was equally likely in cases of two or three affected locations and was reduced in infrainguinal-to-popliteal lesions (Hazard Ratio, HR 0.62, 95% CI 0.44–0.87, p = 0.007) and suprainguinal lesions (HR 0.42, 95% CI 0.21–0.79, p = 0.008). At the limb level, compared to lesions in all three locations, the risk of MALEs was reduced in infrainguinal-to-popliteal lesions (HR 0.51, 95% CI 0.27–0.98, p = 0.044) and was equally likely in all other cases. Conclusions: Amputation-free survival was lowest in cases of infrapopliteal lesions or multi-level disease. At the limb level, isolated infrainguinal-to-popliteal lesions were associated with the lowest risk of MALEs.

Contrast-associated acute kidney injury (CA-AKI) is a known complication of endovascular procedures using an iodinated contrast medium (ICM), especially in patients with peripheral artery disease (PAD) and chronic kidney disease (CKD). This retrospective study evaluated the incidence and risk factors of AKI in patients with PAD and CKD undergoing diagnostic angiography or endovascular intervention using carbon dioxide (CO₂) as the primary contrast medium, with optional bailout ICM use. We included 340 patients who underwent peripheral angiography or intervention between September 2014 and December 2020. CO₂ was used as the primary contrast medium for all patients, as the majority were classified with advanced CKD stages 3–5 according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Bailout ICM was used in 80% of cases (mean 21.23 ± 14.09 mL). Postinterventional AKI occurred in 13.2% of patients, with over 70% classified as stage 1. Seven patients required new dialysis within 7 days. Multivariate analysis identified hypertension, heart failure, and coronary artery disease as independent AKI risk factors. Statin or Renin–Angiotensin–Aldosteron System (RAAS) inhibitor use and higher pre-interventional GFR were protective. AKI remains common in patients undergoing CO₂-guided peripheral procedures. Further studies are needed to explore underlying mechanisms and outcomes.

Background/Objectives: Our aim was to assess the feasibility of hyperspectral imaging (HSI) to detect changes in tissue oxygenation (StO₂) of the back, as non-invasive spinal cord collateral network (CN) monitoring during staged endovascular repair (ER) of thoracoabdominal aortic aneurysm (TAAA). Methods: Between September 2019 and June 2021, 20 patients were treated for TAAA and underwent HSI. They were randomized 1:1 to minimally invasive staged segmental artery coil embolization (MIS2ACE) (n = 10) and staged stentgraft implantation (n = 10) as priming methods. HSI of paravertebral regions was taken during each procedure and up to 10 days after. The primary endpoint was the identification of StO₂ changes after ER of TAAA. Results: TAAA Crawford Type II (n = 17) and Type III (n = 3) were treated. After stentgrafting, StO₂ increased immediately (p < 0.001), followed by a decrease after 5 days (p < 0.001) and 10 days (p = 0.028). StO₂ was significantly higher in the thoracic compared to the lumbar region. There was no significant difference between MIS2ACE and the first stentgrafting for StO₂ (p = 0.491). Following MIS2ACE, definitive ER caused a significant decrease in StO₂ after 5 days (p = 0.021), which recovered to baseline after 10 days (p = 0.130). After stentgraft priming, definitive ER caused a significant decrease in StO₂ after 24 h (p = 0.008), which did not return to baseline after 5 (p < 0.001) and 10 days (p = 0.019). Conclusions: HSI detected significant changes in StO₂ in the thoracic and lumbar paravertebral regions during ER of TAAA. These preliminary data suggest the efficacy of MIS2ACE in priming the CN before ER of TAAA.

Within this single-center cohort study, we investigated the impact of optimal medical therapy on all-cause mortality, major amputation-free survival and clinically driven target lesion revascularization (CD TLR) in 552 patients with peripheral arterial disease (PAD) undergoing endovascular infrapopliteal revascularization. From the overall cohort, 145 patients were treated for intermittent claudication (IC) and 407 were treated for critical limb ischemia (CLI). Optimal medical therapy (OMT) was defined as the presence of at least one antiplatelet agent, statin and ACE inhibitor or AT-2 antagonist based on guideline recommendations. About half (55.5%) of all patients were prescribed OMT at discharge, with a higher proportion in claudicants (62.1%) versus CLI patients (53.2%). Over three years of follow-up, survival was significantly better in patients with IC (80.6 ± 3.8% vs. 59.9 ± 2.9%; p < 0.001). There was a signal towards better survival in those patients receiving OMT (log-rank p = 0.09). Similarly, amputation-free survival (AFS) was significantly better in patients with IC (p = 0.004) and also in patients receiving OMT (78.8 ± 3.6%) compared to that in those without OMT (71.5 ± 4.2%; p = 0.046). Freedom from CD TLR within three years was significantly better in the IC group (p = 0.002), but there were no statistically significant differences for CD TLR dependent on the presence of OMT (p = 0.79). In conclusion, there is still an important underuse of OMT in patients undergoing infrapopliteal interventions, which is even more pronounced in CLI despite a signal for its benefit regarding all-cause mortality and major amputation-free survival.

We aimed to review the feasibility and safe use of the percutaneous axillary artery (AxA, 100 patients) approach for endovascular repair (ER) of thoraco-abdominal aortic aneurysms (TAAA, 90 patients) using fenestrated, branched, and chimney stent grafts and other complex endovascular procedures (10 patients) necessitating AxA access. Percutaneous puncture of the AxA in its third segment was performed using sheaths sized between 6 to 14F. For closing puncture sites greater than 8F, two Perclose ProGlide percutaneous vascular closure devices (PVCDs) (Abbott Vascular, Santa Clara, CA, USA) were deployed in the pre-close technique. The median maximum diameter of the AxA in the third segment was 7.27 mm (range 4.50–10.80). Device success, defined as successful hemostasis by PVCD, was reported in 92 patients (92.0%). As recently reported results in the first 40 patients suggested that adverse events, including vessel stenosis or occlusion, occurred only in cases with a diameter of the AxA < 5 mm, in all subsequent 60 cases AxA access was restricted to a vessel diameter ≥ 5 mm. In this late group, no hemodynamic impairment of the AxA occurred except in six early cases below this diameter threshold, all of which could be repaired by endovascular measures. Overall mortality at 30 days was 8%. In conclusion, percutaneous approach of the AxA in its third segment is feasible and represents a safe alternative access to open access for complex endovascular aorto-iliac procedures. Complications are rare, especially if the maximum diameter of the access vessel (AxA) is ≥5 mm.

Clonal hematopoiesis (CH)-associated mutations increase the risk of atherosclerotic cardiovascular diseases. However, it is unclear whether the mutations detected in circulating blood cells can also be detected in tissues associated with atherosclerosis, where they could affect physiology locally. To address this, the presence of CH mutations in peripheral blood, atherosclerotic lesions and associated tissues was assessed in a pilot study of 31 consecutive patients with peripheral vascular disease (PAD) who underwent open surgical procedures. Next-generation sequencing was used to screen the most commonly mutated loci (DNMT3A, TET2, ASXL1 and JAK2). Twenty CH mutations were detected in peripheral blood of 14 (45%) patients, 5 of whom had more than one mutation. TET2 (11 mutations, 55%) and DNMT3A (8 mutations, 40%) were the most frequently affected genes. Altogether, 88% of the mutations detectable in peripheral blood were also present in the atherosclerotic lesions. Twelve patients also had mutations in perivascular fat or subcutaneous tissue. The presence of CH mutations in PAD-associated tissues as well as in blood suggests that CH mutations may make a previously unknown contribution to PAD disease biology.