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Öğe Acute phase reactant proteins in Buerger's disease: Is it a systemic disease?(2022) Keramat, Shayan; Karahan, Oğuz; Patel, Malay; Fazeli, BahareAim: The aim of this study was evaluating acute phase reactant (APR) proteins including high sensitivity C-reactive protein (hsCRP), pentraxin 3 (PTX3), fibrinogen, complement C3, hepcidin, and albumin in patients suffering from Buerger's disease (BD) compared to controls. Methods: The APRs were evaluated in 92 cases of BD patients and 90 healthy age and sex matched controls of blood from Iran and Turkey. The diagnosis was done according to Shionoya's criteria. However, patients with age less than 40 were included, instead of those less than 50. The diagnosis was confirmed by angiography or CT angiography. The patients were categorized into active and quiescent phases of the disease according to clinical manifestation. Patients with rest pain, non-healing ulcer, and gangrene were categorized in the active phase of the disease and the patients with unchanged claudication for more than 6 months without trophic lesions or gangrene were categorized in the quiescent phase of the disease. Results: The serum level of PTX3, hsCRP, fibrinogen, C3, and hepcidin in BD was significantly higher than controls (p < 0.004). Also, albumin in the BD group was significantly lower than controls (p < 0.001). In patients that categorized in the active phase, fibrinogen, C3, and hsCRP were significantly higher and albumin was significantly lower compared to patients in the quiescent phase. No significant difference was found between the level of PTX3 and hepcidin in the patients in active and quiescent phases of the disease. Conclusion: The pattern of the level of APRs in BD seems more likely systemic inflammatory disorder than atherosclerosis obliterans. More clinical trials for evaluating the efficacy of anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids as a part of management of BD are required. Also, according to low level of albumin in TAO, a protein rich diet might be beneficial for BD patients in the active phase of their disease.Öğe An International Delphi Consensus on Diagnostic Criteria for Buerger's Disease(Elsevier Inc., 2022) Fazeli, Bahare; Poredoš, Pavel; Schernthaner, Gerit Holger; Stephen, Edwin; Kozak, Matija; Catalano, Mariella; Pécsvárady, ZsoltBackground: Buerger's disease (BD) remains a debilitating condition. Despite multiple published diagnostic criteria for BD, none is universally accepted as a gold standard. Methods: We conducted a 2-round modified Delphi consensus study to establish a consensus on the diagnostic. The questionnaire included statements from several commonly used diagnostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agreement level of 70% was applied. Results: Twenty nine experts from 18 countries participated in this study. Overall, 75 statements were circulated in Round 1. Of these, 28% of statements were accepted. Following comments, 21 statements were recirculated in Round 2 and 90% were accepted. Although more than 90% of the experts did not agree that the diagnosis of BD can be based only on clinical manifestation, none of the nonclinical manifestations of BD were agreed as a part of the diagnostic criteria. There was an agreement that a history of tobacco consumption in any form, not necessarily confined to the current use, should be a part of the diagnostic criteria of BD. The history of thrombophlebitis migrans, even if not present at presentation, was accepted as a clue for BD diagnosis. It was also agreed that discoloration of the toes or fingers could be included in the diagnostic criteria of BD. Experts agreed that histology results could differentiate BD from atherosclerosis obliterans and other types of vasculitis. The presence of corkscrew collaterals on imaging and burning pain reached the agreement at the first round but not at the second. There was no consensus regarding age cut-off, the requirement of normal lipid profile, and normal blood glucose for BD diagnosis. Conclusions: The present study demonstrated discrepancies in the various published diagnostic criteria for BD and their selective utilization in routine clinical practice worldwide. We propose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use. © 2022Öğe Diagnostic criteria for Buerger’s disease: International Consensus of VaS - european Independent Foundation in angiology/Vascular Medicine(Edizioni Minerva Medica, 2023) Fazeli, Bahare; Poredoš, Pavel; Kozak, Matija; Pécsvárady, Zsolt; Catalano, Mariella; al-Salman, Mussaad Mohammaed S.; Altarazi, LouayBuerger’s disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the ‘definitive’ diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the ‘suspected’ diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a ‘suspected’ diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway. © 2023 EDIZIONI MINERVA MEDICA.Öğe Guidance for the management of patients with vascular disease or cardiovascular risk factors and COVID-19: Position paper from VAS-European independent foundation in angiology/vascular medicine(Georg Thieme Verlag, 2020) Gerotziafas, Grigoris; Catalano, Mariella; Colgan, Mary Paula; Pecsvarady, Zsolt; Wautrecht, Jean Cladue; Fazeli, Bahare; Farkas, KatalinCOVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH. © 2020 Georg Thieme Verlag. All rights reserved.Öğe Milestones in thromboangiitis obliterans: a position paper of the VAS-European independent foundation in angiology/vascular medicine(Edizioni Minerva Medica, 2021) Fazeli, Bahare; Poredos, Pavel; Patel, Malay; Klein-Weigel, Peter; Catalano, Mariella; Stephen, Edwin; Al Salman, Mussaad M.1School of Medicine, Division of Inflammation and Inflammatory Diseases, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 2Slovenia Academic Research Center, Slovenian Medical Academy, Medical Association of Slovenia and SMA, Ljubljana, Slovenia; 3Department of Vascular Surgery, Apollo-CVHF Hospital, Ahmedabad, India; 4Clinic of Angiology, Zentrum f iota ir Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany; 5Unit of Angiology, Department of Biomedical Science, Research Center on Vascular Disease, L. Sacco Hospital, University of Milan, Milan, Italy; 6Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman; 7Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia; 8Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria; 9National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh; 10Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 11Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland; 12Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia; 13Department of Vascular and Endovascular Surgery, Ramaiah Medical College Hospital, Bangalore, India; 14Unit of Vascular Surgery, Third Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece; 15Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey; 16Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary; 17Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK; 18Hematology and Thrombosis Center, Hopitaux Universitaires de l'Est Parisien, Assistance Publique Hopitaux de Paris, Faculty of Medicine,Öğe The Angiography Pattern of Buerger's Disease: Challenges and Recommendations(Mdpi, 2025) Fazeli, Bahare; Poredos, Pavel; Liew, Aaron; Stephen, Edwin; Bashar, Abul Hasan Muhammad; Kozak, Matija; Catalano, MariellaIn 2023, the VAS international working group on Buerger's Disease (BD) recommended two diagnostic criteria based on a prior Delphi study: definitive and suspected. The definitive criteria are history of smoking, typical angiography, and typical histopathological features. All three features are mandatory to confirm a definitive diagnosis of BD. The conundrum is-what features should be considered typical of BD angiography? According to this review, segmental occlusion of infrapopliteal arteries, corkscrew collaterals that appear to continue the occluded arterial segment (Martorell's sign) or bypass the segmental occlusion, absence of atherosclerotic plaque or aneurysm could differentiate BD from ASO. Hence, for typical BD angiography, these manifestations should certainly be considered. However, data for differentiating angiography patterns of BD from the small- and medium-sized vasculitis including Behcet's disease, scleroderma, hepatitis associated vasculitis, and anti-phospholipid syndrome are limited. Further studies for investigating the angiography pattern in BD patients in early and late presentation of BD, particularly in the patients with long-term follow up, are highly recommended.
