Vascular Medicine (London, England)最新文献

{"title":"Images in Vascular Medicine: Manifestation of vascular collaterals in particle disease.","authors":"Jeff Jin, Matthew Sawyer, Vishal Bansal, Jimmy Pham, Wasay Mohajir, Daniel Wang","doi":"10.1177/1358863X211067567","DOIUrl":"https://doi.org/10.1177/1358863X211067567","url":null,"abstract":"A 77-year-old man presented with complaints of worsening left lower-extremity pain and edema for 3 months. He had a history of venous stasis disease and a left total hip arthroplasty that was performed 20 years ago. Prior to admission, he completed a 2-week course of levofloxacin and metronidazole for presumed cellulitis, but despite antibiotic therapy he continued to have severe, throbbing pain associated with diffuse edema of the entire left lower extremity. Both uninfected macerated tissue and chronic changes secondary to venous hypertension were observed (Panel A). Left lower-extremity ultrasound was negative for deep vein thrombosis. Contrast computed tomography (CT) of the pelvis revealed an extensive 11 × 8.6 × 17.2 cm fluid collection that bordered the acetabular component of the left hip arthroplasty (solid arrows in Panels B-1 and B-2). CT of the left lower extremity also showed compression of the left external iliac vein due to the fluid collection (dashed arrow in Panel B-2) with subsequent formation of venous collateral vessels and varices (arrows in Panel B-3). Chromium (0.6 μg/L) and cobalt (4.3 μg/L) levels were elevated. The patient’s overall clinical scenario was consistent with the formation of a very large pseudotumor secondary to hip arthroplasty metallosis resulting in extrinsic compression of the left external iliac vein. The patient underwent a left hip arthroplasty revision, continued vancomycin and cefepime for 6 weeks after surgery, and transitioned to physical therapy with outpatient follow-up. Particle disease is an inflammatory response to prosthetic wear and debris that causes osteolysis.1 Etiologies of the condition may include the chemical corrosion or physical wear of prosthesis particles – commonly metals, polyethylene, ceramics, and tantalum.1 The increased chromium and cobalt levels in blood further support the diagnosis of particle disease.2 Although treatment is generally surgical revision or debridement, nonsurgical interventions including the use of bisphosphonates, cytokine inhibition, and cell therapy have shown some efficacy.1 Whereas venous compression and thrombosis have been observed in polyethylene prostheses, venous collateralization in the setting of chromium and cobalt prostheses is an extremely rare complication that has not yet been reported in the literature.3,4 Our case demonstrates a rare complication of venous collateralization due to particle disease resulting from a cobalt and chromium hip prosthesis. Further study regarding material selection to minimize the risk of particle disease and nonsurgical therapies for disease management would be beneficial for improved outcomes.","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"403-404"},"PeriodicalIF":3.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39855112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Images in Vascular Medicine: Chronic penetrating nail injury of the common carotid artery.","authors":"Xiang Wang, Haiwei Chu, Wenjun Zhao","doi":"10.1177/1358863X211066968","DOIUrl":"https://doi.org/10.1177/1358863X211066968","url":null,"abstract":"A 55-year-old male carpenter had a history of hypertension and repeat hospitalizations with complaints of dizziness over a 1-year period. Computed tomography angiogram (CTA) showed that the left common carotid artery was penetrated by a metal nail, which had stopped at the 7th cervical anterior edge (Panel A, arrow). Catheter-directed angiogra-phy showed a filling defect of the left common carotid artery (Panel B, arrow). The preoperative physical examination was unremarkable. Upon review of cervical CT scans for","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"401-402"},"PeriodicalIF":3.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39843544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the burden of disease for patients with peripheral artery disease undergoing revascularization in England","authors":"L. Portas, R. Bauersachs, K. Bowrin, J. Briere, Alexander Cohen, M. Huelsebeck, Schuyler W. Jones, J. Quint","doi":"10.1177/1358863X221096704","DOIUrl":"https://doi.org/10.1177/1358863X221096704","url":null,"abstract":"Background: Symptoms, severity, and acuteness of peripheral artery disease (PAD) are major determinants of severe limb symptoms, subsequent risk of cardiovascular events, and mortality. Lower-extremity revascularization (LER) is a key option to relieve symptoms and to prevent limb loss in symptomatic patients with PAD. This study aimed to quantify the burden of disease among patients with PAD-LER in England. Methods: A retrospective population-based study of linked primary and secondary care electronic health records, included 13,869 adult patients (aged ⩾ 18 years) with PAD-LER from 2003 to 2018. The incidence of first ever PAD-LER was estimated both overall and by type of procedure (endovascular/surgical). Health resource utilization associated with PAD-related complications and treatment patterns were assessed. Results: A high annual incidence of lower-limb revascularization (41.2 per 1000 person years) and a nearly double incidence of endovascular first revascularization compared with open surgery were observed. More than 70% of patients with PAD-LER had a history of hyperlipidemia and hypertension and roughly one-third were diabetic and had a history of coronary artery disease. Cardiovascular mortality accounted for one-third (34.1 per 1000 person years) of all-cause mortality. Over 93% of patients were hospitalized for any reason and the commonest reasons for hospitalization were cardiovascular diseases and PAD with about one-third hospitalized for revascularization reoccurrence. Conclusion: There is a significant burden of PAD-LER to the individual and society with ongoing healthcare resource utilization, treatment, and increasing mortality.","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127872669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of ischemic stroke associated with worse clinical outcomes in patients with pulmonary embolism.","authors":"Yong Hoon Lee, Seung-Ick Cha, Jongmin Park, Jae Kwang Lim, Won Kee Lee, Ji-Eun Park, Sun Ha Choi, Hyewon Seo, Seung-Soo Yoo, Shin-Yup Lee, Jaehee Lee, Chang-Ho Kim, Jae-Yong Park","doi":"10.1177/1358863X211055772","DOIUrl":"https://doi.org/10.1177/1358863X211055772","url":null,"abstract":"Pulmonary embolism (PE), which comprises approximately one-third of all venous thromboembolism (VTE),1 exhibits various clinical presentations, ranging from incidentally discovered emboli to hemodynamic instability and death, and its 1-year mortality rate has been reported to exceed 20%.2 Ischemic stroke is one of the major cardiovascular disorders associated with thrombosis as a common pathology along with ischemic heart disease and VTE.3 According to recent studies, the occurrence of PE in patients with ischemic stroke is associated with poor clinical outcomes.4,5 However, information on how the history of ischemic stroke affects patients with PE in terms of clinical manifestations and survival is limited. Thus, the objective of this retrospective study was to investigate whether clinical characteristics and outcomes might differ according to the history of ischemic stroke in patients with PE. Data were collected from patients with PE who were hospitalized between January 2003 and May 2019 at Kyungpook National University Hospital (KNUH), a tertiary referral center in Daegu, South Korea. This study was approved by the Institutional Review Board of the KNUH, which waived the requirement for written informed consent due to its retrospective nature. Patients with PE diagnosed using multidetector-row computed tomography (CT) were included and divided into a stroke group (with a history of ischemic stroke) and a control group (without a prior ischemic stroke). The history of ischemic stroke before the diagnosis of PE was identified by comprehensively reviewing clinical diagnosis and past hospitalization from the medical records, regardless of the time of diagnosis. Clinical characteristics, blood biomarkers, and CT findings were compared between the two groups. To identify predictors of PE-related in-hospital mortality, multivariable logistic regression analysis was performed using Firth’s Penalized Likelihood method. Results of comparisons of clinical characteristics, blood biomarkers, and CT findings are summarized in Table 1. Of 1339 patients with PE, 115 (8.6%) had a history of ischemic stroke. The median follow-up time was 306 days (IQR, 73–1082 days). The proportion of unprovoked PE was lower in the stroke group than in the control group (p = 0.003), whereas the frequency of immobilization was higher (p < 0.001). Comorbidities, including diabetes mellitus (p = 0.035), ischemic heart disease (p = 0.002), and atrial fibrillation (p < 0.001), were more common in the stroke group. Despite the insignificant difference between the two groups in PE severity index (PESI) and CT findings, PE-related in-hospital mortality was significantly higher in the stroke group than in the control group (p = 0.002). The patients were further reclassified into those with (n = 22) and without (n = 1317) PE-related in-hospital death (online supplementary material: Table S1). Variables with p < 0.05 in univariate analysis were included in the multivariable logistic reg","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"293-295"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39909870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular manifestations of hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders.","authors":"Eman R Rashed,&nbsp;Tania Ruiz Maya,&nbsp;Jennifer Black,&nbsp;Veronica Fettig,&nbsp;Daniella Kadian-Dodov,&nbsp;Jeffrey W Olin,&nbsp;Lakshmi Mehta,&nbsp;Bruce D Gelb,&nbsp;Amy R Kontorovich","doi":"10.1177/1358863X211067566","DOIUrl":"https://doi.org/10.1177/1358863X211067566","url":null,"abstract":"<p><p><b>Introduction:</b> Mitral valve prolapse and aortic root dilatation are reported in association with hypermobile Ehlers-Danlos syndrome (hEDS), but the full phenotypic spectrum of cardiovascular complications in this condition has not been studied in the aftermath of updated nosology and diagnostic criteria. <b>Methods:</b> We performed a retrospective review of 258 patients (> 94% adults) referred to a multidisciplinary clinic for evaluation of joint hypermobility between January 2017 and December 2020 and diagnosed with hEDS or a hypermobility spectrum disorder (HSD) to determine the incidence and spectrum of cardiovascular involvement. <b>Results:</b> Mitral valve prolapse was present in 7.5% and thoracic aortic dilatation in 15.2%. Aortic dilatation was more frequent in individuals with hEDS (20.7%) than with HSD (7.7%) and similarly prevalent between males and females, although was mild in > 90% of females and moderate-to-severe in 50% of males. Five individuals (1.9%) with hEDS/HSD had extra-aortic arterial involvement, including cervical artery dissection (CeAD, <i>n</i> = 2), spontaneous coronary artery dissection (SCAD, <i>n</i> = 2), and SCAD plus celiac artery pseudoaneurysm (<i>n</i> = 1). This is the first series to report the prevalence of CeAD and SCAD in hEDS/HSD. <b>Conclusions:</b> Cardiovascular manifestations in adults with hEDS/HSD, especially females, are typically mild and readily assessed by echocardiography. Since the risk of progression has not yet been defined, adults with hEDS/HSD who are found to have aortic dilatation at baseline should continue ongoing surveillance to monitor for progressive dilatation. Cardiovascular medicine specialists, neurologists, and neurosurgeons should consider hEDS/HSD on the differential for patients with CeAD or SCAD who also have joint hypermobility.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"283-289"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677229/pdf/nihms-1850115.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39911236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smaller size is more suitable for pharmacotherapy among undersized abdominal aortic aneurysm: A systematic review and meta-analysis.","authors":"Takuro Shirasu,&nbsp;Hisato Takagi,&nbsp;Jun Yasuhara,&nbsp;Toshiki Kuno,&nbsp;K Craig Kent,&nbsp;W Darrin Clouse","doi":"10.1177/1358863X211061603","DOIUrl":"https://doi.org/10.1177/1358863X211061603","url":null,"abstract":"<p><p><b>Background:</b> Pharmacotherapy for undersized abdominal aortic aneurysm (AAA) is a clinical unmet need. Randomized controlled trials (RCTs) have failed to show effectiveness despite countless promising data in preclinical studies. We aimed to identify the population with undersized AAAs (30-54 mm) who potentially benefit from pharmacotherapy. <b>Methods:</b> In accordance with the PRISMA statement, we conducted a systematic review and meta-analysis of placebo-controlled RCTs. The primary outcome was mean difference (MD) in annual growth rate (< 0 favors pharmacotherapy), and the secondary outcome was aneurysm-related events (diameters ⩾ 55 mm, ruptures, or referral to surgery). <b>Results:</b> Our search strategy identified eight RCTs (six trials on antibiotics [ABx], two on renin-angiotensin system inhibitors [RAS-I]) with a total of 1325 patients. The mean of baseline diameters ranged from 33.1 mm to 43.1 mm. Neither ABx nor RAS-I showed significant differences in MD. Multivariable random-effects restricted maximum likelihood meta-regression revealed a statistically significant linear relationship between baseline diameter and MD (coefficient 0.15 [95% CI 0.0011, 0.30], <i>p</i> = 0.049) but not for the follow-up period (<i>p</i> = 0.28) and duration of treatment (<i>p</i> = 0.11). In line with this result, ABx with baseline diameter < 40 mm significantly reduced MD (-1.03 mm/year [95% CI -1.64, -0.42], <i>p</i> = 0.001) and a borderline significant difference in aneurysm-related events (HR 0.53 [95% CI 0.28, 1.00], <i>p</i> = 0.05), whereas the other groups ⩾ 40 mm never demonstrated effectiveness. Fixed-effect models did not change the results. No evidence of publication bias was detected. <b>Conclusion:</b> Undersized AAAs < 40 mm can potentially benefit from pharmacotherapy. Future RCTs should consider preferentially including undersized AAA with smaller diameters.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"261-268"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39743193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of the stented iliac lesions TASC-II C, D on the femoropopliteal bypass patency: Propensity score-matched observational study.","authors":"Olesia Osipova,&nbsp;Alexey Cheban,&nbsp;Pavel Ignatenko,&nbsp;Pavel Ruzankin,&nbsp;Evgeny Prokopenko,&nbsp;Andrey Karpenko","doi":"10.1177/1358863X211021165","DOIUrl":"https://doi.org/10.1177/1358863X211021165","url":null,"abstract":"<p><strong>Introduction: </strong>Concurrent stenting of complex iliac lesions during infrainguinal bypasses can increase the complexity of a case and impact outcomes.</p><p><strong>Objective: </strong>Our aim was to evaluate the effect of inflow stenting of TASC-II C, D iliac lesions on femoropopliteal bypass patency.</p><p><strong>Methods: </strong>A retrospective observational cohort study of patients who underwent femoropopliteal bypass with TASC-II C, D iliac artery stenting (hybrid group) or without inflow lesions (non-hybrid group) was conducted. After propensity score matching, 120 patients were included in the non-hybrid group and 60 patients in the hybrid one. The median follow-up was 432 (193; 1313) days in the hybrid group and 472 (196; 1376) days in the non-hybrid group (<i>p</i> = 0.94).</p><p><strong>Results: </strong>No significant differences were found between the groups in 30-day morbidity and serious adverse events. At 3 years, primary and secondary bypass patency for the hybrid group and non-hybrid group were 62.2% versus 59.9% (<i>p</i> = 0.36) and 63.7% versus 64.3% (<i>p</i> = 0.077), respectively. The primary patency of the iliac stents in patients of the hybrid group was 95% at 3 years. The estimated hazard ratio for primary patency for hybrid versus non-hybrid was 0.77, with 90% CI: 0.50-1.21; the noninferiority upper bound being 1.31, which corresponds to a 10% additive noninferiority margin for probabilities. The 3 years of freedom from amputation in patients with chronic limb-threatening ischemia was 94.1% and 75.0% in the hybrid and non-hybrid groups, respectively (<i>p</i> = 0.09).</p><p><strong>Conclusion: </strong>The outcomes of the femoropopliteal bypass in hybrid surgery supplemented with stenting of TASC-II C, D iliac lesions was similar to femoropopliteal bypass with intact inflow arteries.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"230-238"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1358863X211021165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39190418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apixaban Discontinuation for Invasive Or major Surgical procedures (ADIOS): A prospective cohort study.","authors":"Geno J Merli,&nbsp;Walter K Kraft,&nbsp;Luis H Eraso,&nbsp;Taki Galanis,&nbsp;Lynda J Thomson,&nbsp;Geoffrey O Ouma,&nbsp;Eugene Viscusi,&nbsp;Jerald Z Gong,&nbsp;Edwin Lam","doi":"10.1177/1358863X211047270","DOIUrl":"https://doi.org/10.1177/1358863X211047270","url":null,"abstract":"<p><p><b>Background:</b> Apixaban pharmacokinetic properties and some clinical reports suggest cessation 48 hours prior to surgery is safe, but this has not been demonstrated in a naturalistic setting. We sought to measure the residual apixaban exposure in patients who had apixaban held as part of standard of care perioperative management. <b>Methods:</b> This was a prospective, observational study of patients in whom apixaban plasma concentration and anti-Xa activity were measured while at steady state apixaban dosing and again immediately prior to surgery. Clinical management of cessation and resumption of apixaban was at the discretion of the treating physician. <b>Results:</b> Paired blood samples were provided by 111 patients. Ninety-four percent (104/111) of patients had measured apixaban concentrations of ⩽ 30 ng/mL. Only one patient had a value > 50 ng/mL. The median time between the self-reported last dose and presurgery blood sampling was 76 hours (range 32-158) for those who achieved concentrations ⩽ 30 ng/mL and 59 hours (range 49-86) for those > 30 ng/mL. Measured anti-Xa activity correlated well with apixaban exposure. Clinically significant nonmajor bleeding was reported in one patient at 1 week postsurgery. There was one venous thromboembolic event and one stroke in the perioperative period. <b>Conclusion:</b> In a naturalistic setting with a heterogeneous patient population, apixaban discontinuation for at least 48 hours before a procedure resulted in a clinically insignificant degree of anticoagulation prior to a surgical procedure. <b>ClinicalTrials.gov Identifier: NCT02935751</b>.</p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"269-276"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39901482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Images in Vascular Medicine: Mid-aortic syndrome caused by subocclusive angiosarcoma.","authors":"Gabriele Pagliariccio,&nbsp;Massimo Mattioli,&nbsp;Silvia Gasparrini,&nbsp;Luciano Carbonari","doi":"10.1177/1358863X211057157","DOIUrl":"https://doi.org/10.1177/1358863X211057157","url":null,"abstract":"A 75-year-old woman presented to our department with a 9-month history of resistant grade 3 hypertension and progressive intermittent claudication of the lower limbs. Despite triple therapy, a recent 24-hour outpatient blood pressure monitor showed high daytime (143/88 mmHg) and night-time (131/81 mmHg) averages. Her history was significant for chronic obstructive pulmonary disease in an active smoker. Physical examination showed weakened femoral pulses and the ankle–brachial index was 0.5. Laboratory tests revealed worsening renal function: blood creatinine value of 2 mg/dL and estimated glomerular filtration rate of 24.3 mL/min/1.73 m2. The electrocardiogram demonstrated sinus rhythm with no pathological findings relevant at echocardiography. Suspecting secondary hypertension, a computed tomography angiogram (CTA) of chest (Panel A-1) and abdomen (Panel A-2) was performed, revealing ectasia of thoracic aorta with extensive thrombotic apposition. These findings involved the descending tract of the aorta and extended up above the emergence of the celiac tripod, showing a severely ulcerated wall causing subtotal vessel occlusion with opacification of the residual lumen (Panel A: arrow) in the filiform posterior marginal site (Panel A: arrows). The superior mesenteric, celiac axis, renal, and inferior mesenteric arteries were atheromatous but patent. Catheter-directed thrombolytic therapy was attempted, with no significant clinical improvement; therefore, a surgical thoracotomy was required. During surgery (Panel B-1), the occluding material was not compatible with thrombosis: a hyaline and lipoid membranous material was removed (Panel B-2). Examination of the specimen diagnosed epithelioid angiosarcoma. Histological examination showed neoplastic cells with large nuclei and prominent nucleoli (Panel B-3: arrowheads; original magnification ×40), occasional intracytoplasmic lumens, and scattered mitotic figures. After surgery, hypertension was within limits and medications were reduced; after rehabilitation, the claudication disappeared. Mid-aortic syndrome is uncommon and is caused by a narrowing of the abdominal and/or thoracic segment of the aorta.1 It is found more frequently in children and young adults, with underlying structural malformations of the aortic wall; patients develop resistant hypertension associated with claudication or intestinal signs of ischemia. Primary tumors of the aorta, such as angiosarcomas, are also rare, and diagnosis is challenging, especially in elderly patients with concomitant atherosclerotic disease; besides the suspicion, histopathological confirmation is mandatory.2 As in Images in Vascular Medicine: Mid-aortic syndrome caused by subocclusive angiosarcoma","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"310-311"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39915772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural outcomes associated with use of the AngioVac System for right heart thrombi: A safety report from RAPID registry data.","authors":"John M Moriarty,&nbsp;Millie Liao,&nbsp;Grace Hyun J Kim,&nbsp;Eric Yang,&nbsp;Kush Desai,&nbsp;Mona Ranade,&nbsp;Adam N Plotnik","doi":"10.1177/1358863X211073974","DOIUrl":"https://doi.org/10.1177/1358863X211073974","url":null,"abstract":"<p><p><b>Background:</b> Right heart thrombi can be a source of considerable morbidity and mortality, especially when associated with pulmonary embolism. <b>Methods:</b> To understand the safety and procedural efficacy associated with vacuum-assisted thrombectomy using the AngioVac System (AngioDynamics, Latham, NY, USA) to remove right heart thrombi, we conducted a subanalysis of the Registry of AngioVac Procedures in Detail (RAPID) multicenter registry representing 47 (20.1%) of 234 participants in the registry. Forty-two (89.4%) patients had thrombi located in the right atrium alone, three (6.4%) in the right ventricle alone, and two (4.3%) in both the right atrium and ventricle. Four (8.5%) patients had concomitant caval thrombi, three (6.4%) also had catheter-related thrombi, and one (2.1%) patient had both caval and catheter-related thrombi with their right heart thrombi. <b>Results:</b> Extracorporeal bypass time was less than 1 hour for 39 (83.0%) procedures. Seventy to 100% removal of thrombus was achieved in 59.6% of patients. Estimated blood loss was less than 250 cc for 43 procedures (91.6%). Mean hemoglobin decreased from 10.7 ± 2.2 g/dL preoperatively to 9.6 ± 1.6 g/dL postoperatively. Transfusions were administered for eight procedures (17.0%), with only one (2.1%) patient receiving more than 2 units of blood. Six patients (12.8%) experienced procedure-related adverse events, including three (6.4%) patients who experienced distal emboli and three (6.4%) patients who developed bleeding-related complications. All adverse events resolved prior to discharge. There was one death (2.1%) reported that was not procedure related. <b>Conclusion:</b> Vacuum-assisted thrombectomy can be performed safely in patients with right heart thrombi. <b>ClinicalTrials.gov Identifier: NCT04414332.</b></p>","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":" ","pages":"277-282"},"PeriodicalIF":3.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39629523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}