Vascular and Endovascular Surgery最新文献

{"title":"Novel Technique for Intentional Occlusion of Directional Branches During Complex Endovascular Aortic Repair Using Microvascular Plugs.","authors":"Andrea Xodo, Jacopo Taglialavoro, Sandro Lepidi, Fabio Pilon, Cristiano Calvagna, Filippo Griselli, Domenico Milite, Giovanni Badalamenti, Barbara Ruaro, Mario D'Oria","doi":"10.1177/15385744231191234","DOIUrl":"10.1177/15385744231191234","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate the feasibility and outcomes of using the microvascular plug (MVP) for intentional occlusion of directional branches (DB) during complex endovascular aortic procedures.</p><p><strong>Case report: </strong>Two patients were treated with the off-the-shelf four-branched Zenith t-Branch thoracoabdominal stent-graft (Cook Medical, Bloomington, Ind). In both cases, the renal arteries (on one side in patient #1 and on both sides in patient #2, respectively) were occluded at time of index intervention. Preoperative planning included the intentional occlusion of each DB with one 7Q-MVP. Technical success was achieved in all cases and maintained at mid-term follow-up (12 months and 36 months, respectively).</p><p><strong>Conclusions: </strong>Use of the MVP appears to be feasible and effective for intentional occlusion of DB during complex endovascular aortic repair. This novel and simple technique may present some unique technical advantages, allowing precise placement of the device while avoiding extension using a bridging stent and DB cannulation with larger sheaths.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"110-114"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors.","authors":"Anouk Van Gerwen, Sarah Gallala, Laura Kerselaers, Dimitri Aerden, Erik Debing","doi":"10.1177/15385744231186276","DOIUrl":"10.1177/15385744231186276","url":null,"abstract":"<p><strong>Introduction: </strong>Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.</p><p><strong>Methods: </strong>All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO.</p><p><strong>Results: </strong>A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (<i>P</i> .015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (<i>P</i> .021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64).</p><p><strong>Conclusion: </strong>The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"34-41"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9746788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durometry for the Assessment of Severity of Post-thrombotic Syndrome and Possible Clinical Applications.","authors":"Ana M Salcedo Mercado, Rubén A Rodríguez Cabrero, Rodrigo Lozano Corona, Javier E Anaya-Ayala","doi":"10.1177/15385744231189023","DOIUrl":"10.1177/15385744231189023","url":null,"abstract":"<p><strong>Background: </strong>Post-thrombotic syndrome (PTS) impacts the patient's quality of life. Available scales to determine its severity remain controversial, therefore, it is of importance to identify new auxiliary methods for the assessment of this sequelae. Measurement of skin hardness (MSH) might be decisive in tracking PTS. The purpose of this study is to assess if the use of durometry is an objective measure to evaluate prognosis of affected limbs in patients with PTS. We compared MSH of extremities with PTS vs healthy limbs, as well as their variation after 3 months of medical treatment to evaluate if durometry can be used to find differences. We strongly believe that measuring and keeping track of skin changes specifically skin hardness can be a useful factor in the prognosis and treatment of PTS.</p><p><strong>Methods: </strong>Prospective cohort study from January 2021 to February 2022 in patients with unilateral PTS. The MSH of the affected limb was compared to the healthy limb. A calibrated durometer was used, 4 measurements were completed at the time of diagnosis and subsequent follow-up were carried out after 3 months of treatment. The percentage of healing (in case of ulcers) and adherence to treatment was carefully monitored. The statistical program R was used.</p><p><strong>Results: </strong>A total of 1088 durometric measurements were performed on 17 patients, and 34 limbs. The MSH in limbs with PTS was 39.09 and in the control limbs (19.8) (<i>P</i> = <.00001). After 3 months of treatment, the MSH in PTS varied in PTS limbs (39.09 to 30.4) (<i>P</i> = <.000012). Adherence to treatment was 70.5%.</p><p><strong>Conclusions: </strong>MSH varied between healthy limbs and the ones with PTS, before and after treatment. Durometry might represent a method for assessing skin changes in patients with PTS.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"54-59"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Uncomplicated Type B Aortic Dissection: Optimal Medical Therapy vs TEVAR + Optimal Medical Therapy.","authors":"Michael Nooromid, Brandon A Creisher, Babak Abai","doi":"10.1177/15385744231184671","DOIUrl":"10.1177/15385744231184671","url":null,"abstract":"<p><p>Optimal Medical Therapy (OMT) has been the accepted mode of treatment for uncomplicated Type B Aortic Dissection (uTBAD). There is growing evidence that despite the short-term benefits of OMT, patients suffer deleterious consequences in the long-term with OMT alone. Thoracic Endovascular Aortic Repair (TEVAR) along with OMT has emerged as an alternative option for patients with uTBAD. This study evaluates the available literature for TEVAR + OMT as an alternative to OMT for treatment of uTBAD. In addition, issues related to TEVAR as a treatment for uTBAD are discussed.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"115-122"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiolymphoid Hyperplasia With Temporal Artery Eosinophilia: A Case Report.","authors":"Ricardo Augusto Carvalho Lujan, Diego Antonio de Melo Mascarenhas, Maurício de Amorim Aquino, Aline Costa Menezes, Marcelo Luis Pereira de Souza Filho, Fernanda Costa Sampaio Silva, Miguel Godeiro Fernandez, Carlos Alberto Silveira Alves, Roque Aras Júnior","doi":"10.1177/15385744231184333","DOIUrl":"10.1177/15385744231184333","url":null,"abstract":"<p><p>Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is a benign vascular proliferative disorder with uncertain etiology and pathogenesis. The aim of this paper is to report a case of ALHE in the temporal artery and discuss the general aspects of this pathology. A 29-year-old female black patient sought the Vascular Surgery Outpatient Service, complaining of bulging in the right temporal region, associated with pain and local discomfort. Physical examination revealed pulsatile bulging in the right temporal region measuring approximately 2.5 × 1.5 cm. Nuclear Magnetic Resonance showed an expansive fusiform lesion in the superficial soft parts of the right temporal region, measuring 2.9 cm in the longest longitudinal axis. Surgical excision proved to be the best therapeutic option for the patient in this case. Histopathological sections showed the proliferation of vessels of different sizes, covered by swollen endothelium, prominent inflammatory infiltrate composed of lymphocytes, plasma cells, eosinophils, and scarce histiocytes. Immunohistochemical analysis of the lesion showed positivity for CD31, corroborating the diagnosis of ALHE.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"95-99"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10068429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneurysm Sac Shrinkage After EVAR Can Lead to Complications: A Case Report of Complete Endograft Thrombosis Due to Kinking.","authors":"Carmen González Canga, Alba Alonso Pastor, Amer Zanabili Al-Sibbai, Fernando Vaquero Lorenzo, Francisco Álvarez Marcos, Manuel Alonso Pérez","doi":"10.1177/15385744231189019","DOIUrl":"10.1177/15385744231189019","url":null,"abstract":"<p><strong>Background: </strong>Bilateral limb occlusion after endovascular repair of abdominal aortic aneurysms (EVAR) is an uncommon entity. The relationship between graft kinking and unilateral limb occlusion is widely described in the literature. Our aim is to report a case of complete endograft thrombosis due to bilateral limb kinking secondary to aneurysm sac shrinkage, treated by endovascular means.</p><p><strong>Case report: </strong>A 67 year-old male with history of EVAR with an Incraft® endograft (Cordis, Bridgewater, NJ, USA) four years before, presented at the emergency department with disabling claudication of the right lower extremity and a better tolerated 10-month left extremity claudication. Complete endograft thrombosis with bilateral limb kinking and a remarkable reduction of the aneurysm sac was observed in the computed tomography angiography. An endovascular repair was performed, through bilateral open femoral access and with angiographic control through percutaneous left brachial access. Bilateral recanalization was achieved and the endograft was re-lined with two 10x150 mm Viabahn (WL Gore & Ass., Flagstaff, AZ, USA). Both sides were extended with a 11 × 50 mm Viabahn (WL Gore & Ass., Flagstaff, AZ, USA). The final angiographic control showed bilateral patency with no residual stenosis and the patient recovered distal pulses. Follow-up showed complete patency and no complications at 17 months.</p><p><strong>Conclusions: </strong>Bilateral limb occlusion is a rare complication with technically challenging treatment options. Aneurysm sac shrinkage can affect the endograft configuration, leading to limb distortion and occasionally to bilateral limb occlusion after EVAR. Special attention should be put on imaging follow-up to detect these complications before occlusion occurs.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"105-109"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paradoxical Embolism Is an Unusual Etiology of Acute Limb Ischemia in Patients Suffering from COVID-19 Infection.","authors":"Jeffrey Lu, Claire Morton, Michael Hall, Khanjan Nagarsheth","doi":"10.1177/15385744231185641","DOIUrl":"10.1177/15385744231185641","url":null,"abstract":"<p><p>Acute limb ischemia (ALI) is a large contributor to morbidity and mortality annually and can be managed either operatively or medically. ALI is most often caused by arterial embolism or in situ thrombosis and treatment is often dependent upon the severity. Anticoagulation is considered standard of care and first line therapy. However, more severe cases of ALI require surgical intervention.Paradoxical emboli are a rare and potentially under-appreciated cause of ALI. They arise when venous emboli, from a variety of sources, traverse a patent foramen ovale (PFO) to enter the arterial system, compromising blood flow to the affected end organ. In most cases, they can only be proven if the thrombus is identified as it crosses the cardiac defect, at which point it is an indication for surgery requiring PFO closure, management for the ischemia itself, and possible intervention for the embolism.In this report, we identify and discuss management of a series of cases where ALI was precipitated by PFOs that were discovered in the context of a pulmonary emboli that developed into paradoxical emboli. All patients had a confirmed diagnosis of COVID-19 which has been associated with a state of hypercoagulability and subsequent thrombus formation.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"13-19"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9667856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of the Chimney Technique in a Community Hospital.","authors":"Denise M D Özdemir-van Brunschot, Maria Tevs, David Holzhey","doi":"10.1177/15385744231185640","DOIUrl":"10.1177/15385744231185640","url":null,"abstract":"<p><strong>Background: </strong>The chimney technique, fenestrated or branched endovascular aortic repair are endovascular options in patients with a juxtarenal, suprarenal or type IV thoraco-abdominal aneurysm. The chimney technique has specific advantages and disadvantages. A retrospective single center study was performed to describe the results.</p><p><strong>Patients and methods: </strong>All consecutive patients in whom the chimney technique was used between 1th January 2011 and 31th December 2020 were included. We excluded patients who needed a revision of an existing EVAR and patients with a para-anastomotic aneurysm. Outcomes were reported in accordance with the reporting standards.</p><p><strong>Results: </strong>38 Patients were included in the study, a total of 59 chimney grafts were deployed. At a median follow-up duration of 26.6 months, there were 9 patients with occlusion of the chimney graft. In 1 patient an iliac renal bypass was performed. In the other patients the renal function stabilized and no further therapy was necessary. All chimneys in the mesenteric arteries remained patent. Gutter endoleak was seen in 5 patients, 3 patients were successfully treated and in the other 2 patients the gutter endoleak disappeared spontaneously.</p><p><strong>Conclusions: </strong>Conclusions should be drawn carefully as this is a retrospective non-comparative study. Results from 38 patients treated with the chimney technique are presented. Chimney graft occlusion rate was 15.3% at the end of follow-up. However, the majority (77.8%) of the occluded stents were self-expandable stents, stressing the importance of selecting the right devices.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"20-28"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9730461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6).","authors":"Christian Baraldi, Daniele Bissacco","doi":"10.1177/15385744231188804","DOIUrl":"10.1177/15385744231188804","url":null,"abstract":"<p><strong>Background: </strong>endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a \"no-scalpel\" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes.</p><p><strong>Methods: </strong>all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions.</p><p><strong>Results: </strong>5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively.</p><p><strong>Conclusions: </strong>EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"60-64"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Artificial Intelligence to Predict Complications After Endovascular Aneurysm Repair.","authors":"Becky Long, Danielle L Cremat, Eduardo Serpa, Sinong Qian, John Blebea","doi":"10.1177/15385744231189024","DOIUrl":"10.1177/15385744231189024","url":null,"abstract":"<p><p><b>Objective:</b> Complications after Endovascular Aneurysm Repair (EVAR) can be fatal. Patient follow-up for surveillance imaging is becoming more challenging as fewer patients are seen, particularly after the first year. The aim of this study was to develop an artificial intelligence model to predict the complication probability of individual patients to better identify those needing more intensive post-operative surveillance. <b>Methods:</b> Pre-operative CTA 3D reconstruction images of AAA from 273 patients who underwent EVAR from 2011-2020 were collected. Of these, 48 patients had post-operative complications including endoleak, AAA rupture, graft limb occlusion, renal artery occlusion, and neck dilation. A deep convolutional neural network model (VascAI^©) was developed which utilized pre-operative 3D CT images to predict risk of complications after EVAR. The model was built with TensorFlow software and run on the Google Colab Platform. An initial training subset of 40 randomly selected patients with complications and 189 without were used to train the AI model while the remaining 8 positive and 36 negative cases tested its performance and prediction accuracy. Data down-sampling was used to alleviate data imbalance and data augmentation methodology to further boost model performance. <b>Results:</b> Successful training was completed on the 229 cases in the training set and then applied to predict the complication probability of each individual in the held-out performance testing cases. The model provided a complication sensitivity of 100% and identified all the patients who later developed complications after EVAR. Of 36 patients without complications, 16 (44%) were falsely predicted to develop complications. The results therefore demonstrated excellent sensitivity for identifying patients who would benefit from more stringent surveillance and decrease the frequency of surveillance in 56% of patients unlike to develop complications. <b>Conclusion:</b> AI models can be developed to predict the risk of post-operative complications with high accuracy. Compared to existing methods, the model developed in this study did not require any expert-annotated data but only the AAA CTA images as inputs. This model can play an assistive role in identifying patients at high risk for post-EVAR complications and the need for greater compliance in surveillance.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"65-75"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}