Regardless of recent advances in PAD treatment, current outcomes remain poor especially in CLI. Despite overwhelming evidence for reduction of limb loss by revascularization, CLI patients still received significantly less angiographies and revascularizations.

In this study vasa vasorum in the walls of porcine coronary arteries were examined, using three-dimensional (3D) micro-CT scanning techniques. These techniques leave the 3D structure of the vasa vasorum tree intact and thus provide a much more direct view of this structure than is possible from conventional histological sections. The study demonstrates-for the first time, we believe-both the different types and the fine architecture of these vasa vasorum. Furthermore, with the use of automated tree analysis software, it was possible to obtain quantitative geometrical data on the 3D structure of vasa vasorum trees that have not previously been available. The results indicate that despite the restrictive topology of the space in which they are present, the branching architecture of the vasa vasorum trees, which we surveyed, is surprisingly similar to that of vasculature in general. The volume of vessel wall tissue perfused or drained by a vasa vasorum tree was found to correlate well with the cross-sectional area of the root segment of the vasa vasorum tree, and the luminal surface area corresponding to this volume was found to be comparable with the surface area of an early atherosclerotic lesion. This is consistent with earlier findings that the ligation or removal of vasa vasorum leads to atherogenesis. Anat Rec Part A 272A: 526 -537, 2003. Published 2003 Key words: vasa vasorum; vessel wall perfusion; vascular branching structure; vascular diseaseThe vasa vasorum have been the subject of considerable interest for more than a century (Koester, 1876), first because of their peculiar function (namely that of supplying blood to the walls of blood vessels), and second because of their possible role in atherogenesis

This population-based analysis documents the significant rise of PAD, particularly of the CLI subset, and highlights the malign prognosis associated with PAD as indicated by high amputation and in-hospital mortality rates.

Aims Drug-eluting devices (DED) represent a well-established therapy being widely used for endovascular revascularization (EVR) of peripheral vessels. Recent data indicate a two-fold increased long-term mortality in patients treated with paclitaxel-based DED. The subsequent safety concerns affected international regulatory authorities to enunciate several alerts for further application of DED. Methods and results In 9.2 million insurants of the German BARMER Health Insurance, data on the application of paclitaxel-based drug-eluting stents (DES) and drug-coated balloons (DCB) were retrieved from their introduction on the market in 2007 until present. All patients with first EVR between 2007 and 2015 were indexed and followed until 31 December 2017. Each subsequently applied DES, DCB, bare-metal stent, and uncoated balloon was included in further analyses. Multivariable Cox regression analysis considered potential non-linear time-dependent hazard ratios (HRs) of DES and DCB over 11 years. We identified 64 771 patients who underwent 107 112 EVR procedures using 23 137 DED. Multivariable Cox regression analysis showed paclitaxel-based DES not to be associated with increased long-term mortality for over 11 years past application (all P > 0.057). DCB was associated with decreased long-term mortality for the first year past application (HR 0.92; P < 0.001), and indifferent correlation in the years thereafter (all P > 0.202). Conclusion Our real-world analysis showed no evidence for increased mortality associated with paclitaxel-based DED for over 11 years.

This hospitalization-based analysis revealed a marked increase of NSTEMI among constant AMI frequency. Despite all current efforts, in-hospital mortality was stagnating on a high level compared with data of RCTs.

Gö ssl, M., N. M. Malyar, M. Rosol, P. E. Beighley, and E. L. Ritman. Impact of coronary vasa vasorum functional structure on coronary vessel wall perfusion distribution. Am J Physiol Heart Circ Physiol 285: H2019-H2026, 2003. First published July 10, 2003 10.1152/ajpheart.00399.2003.-Noncoronary vasa vasorum have been described as networks of microvessels in the wall of arteries and veins. However, we have shown, using microcomputerized tomography (micro-CT) imaging methods, that porcine coronary vasa vasorum have a tree-like branching structure similar to the vasculature in general. In this study, we elucidate functional aspects of coronary vasa vasorum perfusion territories. Three pig hearts were injected with radiopaque Microfil via the coronary sinus to fill the left anterior descending coronary arteries (LADs) retrogradely at atmospheric pressure. In three other hearts, LADs were injected antegradely at 100-mmHg pressure via the left main carotid artery. Additionally, six LADs were injected in vivo with a suspension of 100-or 300-m-diameter microspheres before harvesting of the hearts and injection of the LADs with Microfil. All harvested LADs were scanned intact with micro-CT (20 m cubic voxels). The spatial density of vasa vasorum (no. of vasa/mm 2 ) was measured in 20-m-thick cross sections (at 0.4-mm intervals). Retrogradely injected LADs showed high and uniformly distributed vasa vasorum densities in the adventitia (means Ϯ SE; 5.38 Ϯ 0.09 vs. 3.58 Ϯ 0.1 vasa/mm 2 in antegradely prepared LADs; P Ͻ 0.001). Antegradely prepared LADs showed patchy distributed, low-vasa-vasorumdensity territories especially on the myocardial side of the coronary artery wall (epicardial density: 4.29 Ϯ 0.13 vasa/ mm 2 vs. myocardial density: 2.80 Ϯ 0.1 vasa/mm 2 , P Ͻ 0.001). Microembolization reduced vasa vasorum densities significantly (100-m-diameter microspheres: 3.26 Ϯ 0.07 vasa/mm 2 , P Ͻ 0.05; 300-m-diameter microspheres: 2.66 Ϯ 0.07 vasa/mm 2 , P Ͻ 0.001 vs. antegrade controls) and increased the size of low-vasa-vasorum-density territories. We conclude that coronary vasa vasorum are functional endarteries not connected via a plexus. This characteristic may have a significant impact on the spatial distribution of perfusion and drainage of the coronary vessel wall.intraluminal coronary artery pressure; microembolization; microcomputerized tomography VASA VASORUM HAVE BEEN DESCRIBED as a "network" or "plexus" of microvessels located in the vessel wall of arteries and veins responsible for nutrient supply to and drainage from the vessel wall (2, 9, 21, 24, 25). A recent study by our group (5) using microcomputerized tomography (micro-CT) showed, however, that the general structure of coronary vasa vasorum is "treelike," consistent with endarteries. Furthermore, we could show that despite the constrained topology of the space in which they proliferate, the hemodynamic characteristics of coronary vasa vasorum are surprisingly similar to that of the vasculature in general. Although several investigators (6,14,17) have sh...

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SUMMARYBackground: Declining amputation rates have been reported in multiple countries in recent years. It is not yet known whether amputation rates have declined in Germany as well.