Eliza Russu

The pathological deposition of amyloid-β (Aβ) in the walls of cerebral blood vessels as cerebral amyloid angiopathy (CAA) is a key feature of Alzheimer’s disease (AD) and is linked to impaired clearance of Aβ via intramural periarterial drainage (IPAD). The spontaneous contractions of cerebral smooth muscle cells (SMCs) are thought to drive IPAD, but the relationship between vascular aging and Aβ accumulation remains unclear. We propose a unified framework centered on cerebral intramural cells (CICs), including arterial SMCs, specialized pericyte subtypes, as mediators of vascular dysfunction and neurodegeneration. We integrate current evidence from studies of cerebral small vessel disease, blood–brain barrier (BBB) dysfunction, pericyte biology, vascular aging, cerebral perfusion, and IPAD. CICs regulate vasomotion, capillary flow, BBB integrity, and IPAD. Their dysfunction impairs perfusion and protein clearance, increasing vulnerability in white matter and the hippocampus. These vascular alterations interact with amyloid and inflammatory processes, contributing to synaptic dysfunction, network disconnection, and neurodegeneration. CICs represent potential therapeutic targets. A CIC-centered framework may help explain the links between vascular dysfunction, impaired Aβ clearance, and neurodegeneration in AD and CAA.

Background/Objectives: The autologous arteriovenous fistula (AVF) is the primary vascular access (VA) method for hemodialysis (HD), with superior patency and a lower complication rate than arteriovenous graft (AVG) or central venous catheter (CVC). The primary objective of this study is to analyze the impact of dialysis on the CVC at the time of AVF creation on its long-term primary patency. Methods: This retrospective, single-center, observational study included 248 patients admitted for AVF creation. Demographic characteristics, comorbid conditions, and laboratory parameters were retrieved from the hospital’s electronic medical records. The primary outcome of the study was long-term AVF failure, defined as the inability to perform hemodialysis through the newly created AVF. Results: A total of 132 (53.2%) were receiving dialysis via a CVC at the time of AVF creation. During a mean follow-up of 2.21 ± 1.54 years, 47 patients (18.95%) failed to achieve functional maturation at 6 weeks, and 81 patients (32.66%) developed long-term AVF failure. Demographic characteristics were similar between patients with and without CVC at AVF creation, with no significant differences in age (p = 0.358) or sex (p = 0.574). Comorbidities and risk factors were also similarly distributed, showing no significant variation. The types of AVF varied by CVC status, with fewer RC-AVF (p = 0.038) and more BC-AVF (p = 0.032) in patients with a CVC. Failure was significantly more frequent in patients with CVC use at the time of AVF creation than in those without CVC (p < 0.001). Kaplan–Meier analysis demonstrated lower long-term patency in patients dialyzed via CVC (p < 0.001). In Cox regression analysis, dialysis via CVC at AVF creation was associated with AVF failure (HR: 2.53, p < 0.001), and the association remained significant after full adjustment (HR: 3.13, p < 0.001). Female sex, active smoking, smaller arterial and venous diameters, and RC-AVF were additional risk factors associated with failure. Conclusions: Dialysis via a CVC at the time of AVF creation was associated with an increased risk of long-term AVF failure, even after full adjustment models.

Introduction: Accurately measuring tissue thickness is a crucial technical aspect and a source of bias in biomechanical analysis, as even minor errors can substantially affect stress, elasticity, and tissue behavior. This study analyzes the reproducibility and consistency of specimen thickness measurements by experienced users using a digital caliper under two protocols and a specialized device under a third, also assessing the impact on biomechanical properties. Method: The current study is a methodological study in which we examined the thickness of the porcine arterial wall, specifically segments from the aorta, carotid, and coronary arteries. For the first two protocols, thickness measurements were performed using a digital vernier caliper (Multicomp PRO MP012475), whereas a dedicated digital thickness gauge (Mitutoyo 547-500S, Kawasaki, Japan) was employed for the third protocol. Biomechanical testing was conducted using a BioTester® 5000 (CellScale, Canada), fitted with two opposing BioRakes mounted on actuators to apply uniaxial tensile loading at 25% and 50% stretch. Results: For coronary artery wall thickness measurements, significant protocol-dependent differences between novice users for Protocol 1 and Protocol 3 (p = 0.0384), and for intermediate users using the same protocols (p = 0.0122). The mechanical response of porcine vascular tissues at 25% and 50% stretch was not influenced by operator experience, as no statistically significant differences in Cauchy stress were observed among users across the three experimental protocols. Conclusion: This study demonstrates that the method used to measure arterial wall thickness influences reproducibility, particularly in thin-walled vessels such as coronary arteries, and when performed by less experienced users.

Background: Non-anastomotic pseudoaneurysm formation due to very late prosthetic graft failure after femoropopliteal bypass is exceptionally rare. Case Presentation: We describe a 73-year-old blind man who presented with rapid enlargement of a mid-thigh mass on the left side, associated with skin necrosis. His history included advanced atherosclerosis with bilateral superficial femoral artery occlusion and prior femoropopliteal bypasses: a right-sided great saphenous vein graft (2006) and a left-sided Dacron^® graft (2008). Computed tomography angiography revealed a giant pseudoaneurysm originating from the mid-portion of the left bypass graft (13.8 × 16.5 cm) with active contrast extravasation and distal popliteal artery occlusion, as well as a large, well-defined lateral thigh lipoma. Open surgery revealed structural graft disruption within the prosthetic body and a large chronic pseudoaneurysm sac containing organized thrombus. En bloc pseudoaneurysm excision and graft exclusion without reconstruction were performed, followed by soft-tissue reconstruction. The postoperative course was uneventful, with complete wound healing by four weeks and no ischemic symptoms during 18 months of follow-up. This exceptionally late prosthetic graft complication underscores the need for long-term surveillance in patients with lower-limb bypass grafts. Conclusions: This case highlights that prosthetic graft failure may occur very late and present insidiously. Recognition of this rare complication is essential for timely diagnosis and individualized surgical management.

Background: Vascular leiomyosarcoma (LMS) is an exceptionally rare and aggressive soft tissue sarcoma arising from the smooth muscle cells of the vascular wall. They account for approximately 0.5–2% of adult soft-tissue sarcomas and are the most frequent primary malignancy of vascular origin. Among venous sites, the inferior vena cava (IVC) is the most frequently involved, accounting for more than half of reported vascular LMS cases, with rarer occurrences in peripheral veins, including the internal saphenous vein and the external iliac vein. Case Presentation: We report a case series comprising two distinct presentations of vascular LMS involving the internal saphenous vein and the inferior vena cava, respectively. Each case highlights unique clinical manifestations, radiologic features, histopathologic diagnosis, and therapeutic challenges inherent to the involved vascular territory. Surgical resection with clear margins was the primary treatment modality, complemented by adjuvant therapies tailored according to tumor grade and extent. Literature Review: An updated literature review contextualizes these findings, detailing epidemiology, diagnostic challenges, prognostic factors, and current management approaches. It emphasizes the rarity of leiomyosarcomas originating from major venous pathways and highlights variability in clinical presentation, tumor size, growth patterns, and outcomes. Achieving complete surgical removal with negative margins continues to be the primary treatment goal and the most significant prognostic factor. Conclusions: Given the paucity of cases, our series contributes valuable insights into the clinical spectrum and multidisciplinary approach necessary for optimal outcomes in vascular LMS. Early recognition and aggressive treatment remain paramount to improving survival in this rare malignancy.

We report the case of a 44-year-old man with end-stage kidney disease (ESKD) who has been on chronic hemodialysis via a radio-cephalic arteriovenous fistula (RC-AVF) for one year. The patient arrived at the emergency department due to an inability to continue dialysis through the AVF. Clinical and ultrasound exams reveal an aneurysm in the cephalic vein, measuring 2.3 cm (cm) in diameter and 5 cm long, located in the middle third of the forearm, with intraluminal thrombosis. A surgical procedure is planned to exclude the aneurysmal segment and reconnect the vein, using a graft made from a bovine pericardium patch. Immediately after surgery, a thrill is detectable, and ultrasound shows a flow rate of 651 mL/min. On the second day, dialysis is performed through the distal cephalic vein segment under ultrasound guidance, avoiding the median forearm zone. At one month, the fistula remains functional, with no signs of thrombosis or stenosis. The bovine pericardium tubular graft has shown complete integration. This case supports the feasibility, safety, and potential advantages of using a tubularized bovine pericardial graft as an alternative conduit for RC-AVF reconstruction in select patients. However, further studies on larger cohorts and with extended follow-up are necessary to validate its reproducibility and long-term patency.

Atherosclerosis is now recognized as a chronic inflammatory disease of the arterial wall, in which perivascular adipose tissue (PVAT) has evolved from a passive structural component to a key player in regulating vascular homeostasis and the pathophysiology of atherosclerosis, playing an active, not just structural, role. PVAT surrounds blood vessels and influences them metabolically, immunologically, and vascularly by secreting adipokines, cytokines, and other bioactive mediators. Under physiological conditions, PVAT has protective roles, as it produces adiponectin, nitric oxide (NO), and other vasodilatory factors that help maintain vascular tone and reduce inflammation. In particular, brown-like PVAT (rich in Uncoupling Protein-1 (UCP1) and mitochondria) offers significant vasoprotective effects. Under pathological conditions (obesity, dyslipidemia, insulin resistance), PVAT undergoes a phenotypic transition towards a pro-inflammatory profile by increasing leptin, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) secretion and decreasing adiponectin, contributing to endothelial dysfunction, vascular smooth muscle cell (VSMC) proliferation, local immune cell recruitment, extracellular matrix (ECM) remodeling, and fibrosis. PVAT plays a complex role in vascular health and disease, interacting with systemic metabolism through the secretion of bioactive molecules. Metabolic imbalances can promote PVAT inflammation. Epigenetic alterations and micro ribonucleic acid (miRNAs) can influence PVAT inflammation, and modern imaging methods for PVAT assessment, such as the fat attenuation index (FAI) and artificial intelligence-assisted radiomic profiling, may become predictive biomarkers of cardiac risk. Future directions aim to identify biomarkers and develop targeted therapies that modulate PVAT inflammation and dysfunction in the context of cardiovascular diseases.

We appreciate the insightful commentary by Mengyi Lian and Chengwei Zhang regarding our manuscript “Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients”

Background/Objectives: According to the guidelines established by the European Society of Vascular Surgery (ESVS), a minimum 2 mm diameter is advised for both the radial artery (RA) and cephalic vein (CV) to perform a radio-cephalic arteriovenous fistula (RC-AVF). However, studies have suggested that larger vein diameters, over 2.5 or 3 mm, or even smaller vessel diameters, above 1.6 mm, can yield satisfactory outcomes in both the medium and long term. This study aims to analyze how preoperative vascular mapping influences the long-term RC-AVF failure, considering adherence to guidelines. Methods: This retrospective, monocentric, and observational study enrolled 110 patients with ESKD who were admitted, between 2018 and 2024, to the Vascular Surgery Department at the Emergency County Hospital of Târgu Mureș for the creation of an RC-AVF. Demographic characteristics, comorbidities, preoperative vascular mapping data, and laboratory data were meticulously collected from the hospital’s electronic databases. Patients enrolled in the current study were categorized into two groups based on their adherence to guideline recommendations. Results: Patients whose RC-AVF was created outside guideline recommendations demonstrated smaller arterial (p < 0.001) and venous (p < 0.001) diameters. Additionally, a higher percentage of these patients were on hemodialysis via CVC at the time of RC-AVF creation (p = 0.041), as well as a higher incidence of 6-week AVF maturation failure (p = 0.012) and long-term AVF failure (p = 0.016). In ROC Curve analysis, a threshold of 2.75 mm was established for the RA (AUC: 0.647, p = 0.005) and 2.52 mm for the CV (AUC: 0.677, p = 0.001). Additionally, patients whose RC-AVF procedures adhered to guideline recommendations had a significantly lower risk of long-term RC-AVF failure (HR: 0.44, p = 0.012). This association lost significance after adjusting for cardiovascular risk factors and the presence of CVC at admission (HR: 0.69, p = 0.328). After full adjustment, only the CV remained an independent predictor of long-term successful RC-AVF (HR: 0.68, p = 0.026). In contrast, RA lost significance after adjusting for cardiovascular risk factors and the presence of CVC at admission (HR: 0.71, p = 0.086). Conclusions: In conclusion, this study reveals that only the diameter of the CV is correlated with the long-term failure of RC-AVF, independent of age, gender, diabetes, hypertension, active smoking, and the presence of a CVC at the time of AVF creation. Therefore, while adhering to the threshold diameters of the AR and CV, as recommended by the ESVS guidelines, facilitates the creation of a functional RC-AVF, we assert that additional cofactors, such as demographic data, usual cardiovascular risk factors, or CVC presence, must also be considered to achieve optimal long-term AVF.

Background/Objectives: Cardiovascular disease remains the leading global cause of death, with atherosclerotic plaque vulnerability, rather than stenosis severity, playing a central role in acute coronary events. Epicardial adipose tissue (EAT) has emerged as a key contributor to coronary atherosclerosis and myocardial ischemia. This study aimed to investigate the relationship between EAT thickness and the development and severity of atherosclerotic plaques in these coronary arteries, and to evaluate the influence of demographic factors on EAT thickness and plaque vulnerability. Methods: A retrospective analysis was conducted on autopsy data from 245 sudden cardiac death (SCD) cases (2021–2023). EAT thickness was measured at the left anterior descending artery (LAD) and left circumflex coronary artery (LCx) levels. From each artery, one segment that showed evidence of an atherosclerotic plaque was collected and sent for histological examination. Additionally, we documented demographic data, including age, sex, and body mass index (BMI) for each case. Results: In the present study, we enrolled 245 subjects with SCD, among whom 175 (71.42%) were male, and 70 (28.58%) were female. The mean age was 62.31 ± 12.69 years, and the mean BMI was 26.12 ± 4.16. We observed a mean EAT thickness value of 0.74 ± 0.26 cm at the LAD artery level and 0.71 ± 0.27 cm at the LCx artery level. We observed a positive correlation between BMI and EAT thickness at the LAD level (r = 0.260, p < 0.001) and similarly at the LCx level (r = 0.260, p < 0.001). Additionally, advancing age is associated with an increase in EAT thickness at both the LAD level (r = 0.188, p = 0.003) and the LCx level (r = 0.242, p < 0.001). Furthermore, we observed a higher EAT thickness at the LAD level (p = 0.0019) and the LCx level (p = 0.0225) among subjects with unstable atherosclerotic plaques. In the logistic regression analysis, the elevated value of EAT thickness was associated with unstable atherosclerotic plaque at LAD (OR: 1.88, p = 0.002) and LCx (OR: 1.51, p = 0.010) for the entire study cohort. Conclusions: Our data revealed that higher baseline values of EAT LCx and EAT LAD are associated with unstable plaque at the level of the left coronary arteries. Furthermore, our findings indicate that male individuals are more susceptible to developing unstable plaques in the coronary arteries.