Vascular最新文献

{"title":"The role of the HALP score in determining the severity of lower extremity peripheral arterial disease.","authors":"Çağatay Tunca, Alperen Taş, Saadet Demirtaş İnci","doi":"10.1177/17085381251330370","DOIUrl":"https://doi.org/10.1177/17085381251330370","url":null,"abstract":"<p><p>ObjectivePeripheral artery disease (PAD) is a chronic circulatory disorder characterized by atherosclerotic plaque buildup in the peripheral vascular system, restricting blood flow to the lower extremities and carrying a significant risk of morbidity and mortality. This study investigates the role of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic marker for assessing the severity of lower extremity peripheral artery disease (LEAD). The HALP score integrates hematologic and nutritional markers, providing a composite index that may reflect both the inflammatory and nutritional states impacting LEAD progression.MethodsA cross-sectional retrospective study was conducted, analyzing 186 patients diagnosed with LEAD through peripheral angiography. Participants were classified according to the TransAtlantic Inter-Society Consensus (TASC) II criteria, with mild to moderate disease (TASC A-B) and severe disease (TASC C-D). Laboratory data were collected within the first week of diagnosis, and HALP scores were calculated. The association between HALP scores and LEAD severity was evaluated through correlation and logistic regression analyses. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were also analyzed.ResultsSignificant differences were observed between TASC A-B and TASC C-D groups in demographic and clinical variables. Patients in the severe LEAD group were older, had a higher prevalence of diabetes and hyperlipidemia, and exhibited lower hemoglobin and albumin levels with higher platelet counts (<i>p</i> < .001). A significant inverse correlation was found between HALP score and LEAD severity (R = -0.607, <i>p</i> < .001), indicating that lower HALP scores are associated with more advanced disease. The HALP score displayed strong discriminatory performance in ROC analysis (AUC = 0.889), with an optimal cut-off of 3.14 providing 81% sensitivity and 80% specificity for predicting severe LEAD.ConclusionThe HALP score is a valuable, non-invasive predictor of LEAD severity and may serve as a practical tool for clinical risk assessment. Incorporating the HALP score into routine evaluation protocols could support more personalized management approaches for patients with LEAD, guiding both therapeutic decisions and long-term monitoring.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251330370"},"PeriodicalIF":1.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731704","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":"Unstented large fenestration for close target vessel ostia: Long-term follow-up.","authors":"Lorenzo Torri, Giuseppe Panuccio, Petroula Nana, Jose Ignatio Torrealba, Tilo Kölbel","doi":"10.1177/17085381251328062","DOIUrl":"https://doi.org/10.1177/17085381251328062","url":null,"abstract":"<p><p>PurposeTo report the 10-year follow-up of a patient managed with a custom-made fenestrated endograft, including a large fenestration for the preservation of a celiac trunk (CT) anatomic variation.Case reportIn 2014, a 75-year-old female was treated endovascularly for descending thoracic and visceral aortic pseudoaneurysms (PA). Due to a celiac trunk (CT) anatomic variation, consisting of separate origins of the hepatic and splenic artery, a custom-made four-fenestrated endograft was planned, including a large fenestration (18 × 10 mm) for CT preservation. Balloon-expandable covered stents bridged all target vessels (TVs), except the large fenestration, which was left unstented. Imaging at 10 years showed patency of TVs, no signs of instability or device migration and complete PA exclusion.ConclusionUsing a patient-specific device for complex endovascular aortic repair provided favorable extended follow-up outcomes. An unstented large fenestration remained patent during 10 years of follow-up. This case highlights the importance of individualized approach in complex aortic pathologies.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251328062"},"PeriodicalIF":1.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658743","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":"An experimental study of a novel high-precision iliac vein pressure measuring device to evaluate iliac vein compression syndrome.","authors":"Liguo Liu, Xiangchen Dai, Xiujun Zhang, Junjie Huang, Ziyuan Zhao, Cunfa Liu","doi":"10.1177/17085381251325652","DOIUrl":"https://doi.org/10.1177/17085381251325652","url":null,"abstract":"<p><p>ObjectiveThis study aims to assess the clinical value of a novel high-precision iliac vein pressure measuring device to diagnose and treat iliac vein compression syndrome.MethodsA total of 38 patients with clinically confirmed iliac vein compression syndrome (all lesions on the left side) were selected. The iliac vein pressure and pressure recovery time (time taken for pressure to return to resting levels) were measured in four states: rest, affected limb elevation, ankle extension and flexion, and gastrocnemius muscle compression. Bilateral comparisons and pre- and post-treatment assessments were conducted.ResultsThe left iliac vein pressure in the four states (42.40 ± 16.08 mmH₂O, 51.23 ± 17.63 mmH₂O, 70.26 ± 25.55 mmH₂O, and 111.47 ± 58.78 mmH₂O) and pressure recovery time (25.57 ± 10.65 s) were significantly higher compared to the right iliac vein pressure (30.67 ± 7.46 mmH₂O, 36.55 ± 8.59 mmH₂O, 44.84 ± 11.17 mmH₂O, and 52.96 ± 14.06 mmH₂O) and recovery time (18.92 ± 21.07 s) (<i>p</i> = .000). The pressure in patients with left iliac occlusion (179.07 ± 31.64 mmH₂O) was significantly higher than in patients with stenosis (79.91 ± 33.54 mmH₂O) (<i>p</i> = .000). In eight patients who underwent intraluminal iliac venous therapy, postoperative pressure (37.29 ± 7.53 mmH₂O, 44.74 ± 5.10 mmH₂O, 53.76 ± 5.36 mmH₂O, and 61.96 ± 7.27 mmH₂O) and pressure recovery time (20.88 ± 5.67 s) significantly improved compared to preoperative measurements (50.53 ± 8.21 mmH₂O, 60.03 ± 7.50 mmH₂O, 96.88 ± 11.67 mmH₂O, 177.11 ± 22.40 mmH₂O, and 35.50 ± 6.95 s) (<i>p</i> < .01). Despite improvements, postoperative left iliac pressure remained significantly higher than the right iliac pressure in different states (<i>p</i> < .05). The left iliac vein pressure increased significantly during ankle extension and flexion, as well as gastrocnemius muscle compression compared to resting and elevated limb states (<i>p</i> < .05).ConclusionThe innovative high-precision iliac vein pressure measuring device enables rapid and accurate quantification of iliac vein pressure. As a functional diagnostic method, it holds considerable clinical value in diagnosing iliac vein compression syndrome and evaluating treatment efficacy.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251325652"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650982","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":"Diagnosis of prosthetic vascular graft infection using the management aortic graft infection collaboration (MAGIC) criteria.","authors":"Mu'ath Adlouni, Daanish Sheikh, Vy Dang, Ezra Y Koh, Brandon Fong, Raniyah Nathani, Maham Rahimi","doi":"10.1177/17085381251326995","DOIUrl":"https://doi.org/10.1177/17085381251326995","url":null,"abstract":"<p><p>BackgroundVascular graft infection (VGI) is a devastating complication that necessitates immediate diagnosis to reduce morbidity and mortality. In 2016, The Management of Aortic Graft Infection Collaboration (MAGIC) proposed a diagnostic algorithm for identifying aortic graft infection which uses clinical, radiological, and laboratory findings to determine risk. The purpose of this study was to retrospectively validate the MAGIC criteria for VGI diagnosis and potentially broaden its application.MethodsAn IRB approved retrospective cohort study was performed with 28 suspected VGI patients from our institution. A blinded chart review categorized patients based on MAGIC criteria into \"infected,\" \"suspected infection,\" or \"insufficient evidence\" groups. Due to the MAGIC criteria's placement of a third outcome, \"suspected infection,\" the results were dichotomized into two systems whereby \"suspected infection\" patients were considered as infected (S = I) or uninfected (S = NI). Both dichotomized systems from the MAGIC criteria were then compared to the clinical diagnosis (with surgical evidence when possible) from which sensitivity and specificity were calculated.ResultsA total of 15 patients (54%) presented with definitive VGI, two patients (7%) presented with suspicion for VGI, and 11 patients (39%) presented with insufficient evidence to suspect VGI; placement in these categories were determined by the MAGIC criteria at entry to the study. When using clinical diagnoses, 17 out of 28 had VGI (61%). When using the categorization system S = I, sensitivity was 88.2% and specificity of 100%, for S = NI, sensitivity dropped to 76.4%, but specificity remained at 100%. These results were recomputed using only 25 of the 28 patients who were good surgical candidates. Using this new surgical threshold and smaller cohort to compare MAGIC against, sensitivity was calculated to be 93.3% with a specificity of 100% when S = I. When S = NI, the sensitivity was calculated to be 86.7% with specificity remaining at 100%.ConclusionsThe MAGIC criteria provide excellent specificity and reasonable sensitivity for diagnosis of VGI for peripheral and aortic revascularization.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251326995"},"PeriodicalIF":1.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626178","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":"Feasibility of tomographic freehand three-dimensional ultrasound for surveillance of abdominal aortic aneurysms after endovascular repair.","authors":"Rianne E van Rijswijk, Suzan R T Everink, Jelmer M Wolterink, Michel M P J Reijnen, Erik Groot Jebbink","doi":"10.1177/17085381251327171","DOIUrl":"https://doi.org/10.1177/17085381251327171","url":null,"abstract":"<p><p>ObjectivesThis study aimed to investigate the feasibility of a commercially available tomographic freehand three-dimensional ultrasound (3D-US) system for surveillance of abdominal aortic aneurysms (AAAs) after endovascular repair (EVAR).MethodsIn 10 patients who underwent EVAR, a 3D-US scan was obtained post-operatively in addition to regular computed tomography angiography (CTA). Five independent observers evaluated 12 EVAR surveillance parameters for the 10 scans, resulting in a total of 600 individual observations.ResultsThe diameters of the neck, sac and iliac arteries were evaluable in most of the observations (neck: 80%, AAA sac: 98%, right CIA: 90%, left CIA: 68%). The diameter measurements of the 3D-US strongly correlated with the diameters measured on CTA (<i>ρ</i> = 0.90, <i>p</i> < .001). The general offset of 3D-US compared to CTA was -4.4 mm and the proportional bias was 3%. For all observers, the diameter measurements were significantly strongly correlated (O1:ρ = 0.85, O2:ρ = 0.88, O3:ρ = 0.93, O4:ρ = 0.96, O5:ρ = 0.86, <i>p</i> < .001 for all). The inter-observer reliability was excellent with an overall concordance correlation coefficient of 0.98. The start of the endograft, the lowest renal artery, the distance between these landmarks, and the proximal and distal sealing zones were evaluable in fewer than half of the observations (42%, 12%, 10%, 32%, 32%, 26%).Conclusion3D-US after EVAR is feasible. Diameters measured in 3D-US correlate strongly with CTA-based diameters and have a good interrater variability. However, the sealing zones are difficult to assess on 3D-US. This technique could be a useful addition to duplex ultrasound to facilitate offline 3D analysis, increase measurement reproducibility, enable volume measurements, and minimise the use of harmful CTA for surveillance after EVAR.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251327171"},"PeriodicalIF":1.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626234","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":"Assessing the prognostic value of HALP score in peripheral artery disease: Correlation with lesion severity and long-term mortality.","authors":"Ali Evsen, Adem Aktan, Raif Kılıç, Abdulaziz Yalçın, Mehmet Özbek","doi":"10.1177/17085381251327000","DOIUrl":"https://doi.org/10.1177/17085381251327000","url":null,"abstract":"<p><p>IntroductionPeripheral artery disease (PAD) poses a growing clinical challenge due to an aging population, despite advances in treatment methods. Various scoring systems have emerged to predict high-risk patients, including the HALP (hemoglobin, albumin, lymphocyte, and platelet) score, known for predicting prognosis in cancers and stroke. This study assesses the HALP score's relation to lesion severity and long-term mortality in PAD patients.MethodsWe retrospectively analyzed 305 symptomatic PAD patients undergoing endovascular intervention. The following formula was used to calculate the HALP score: hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L) / platelet count (/L). Lesion severity was classified by TASC-II: TASC AB and TASC CD. Mortality data were obtained from hospital and social security records.ResultsThe study involved 305 patients (mean age 64.4 ± 11.8 years; 72.1% male), divided into survivors (208) and non-survivors (97). ROC analysis identified HALP score as the strongest predictor of long-term mortality (AUC: 0.736; 95% CI: 0.679-0.793; <i>p</i> < .001). HALP score (HR, 0.087; 95% CI, 0.025-1.300; <i>p</i> < .001), age (<i>p</i> < .001), DM (<i>p</i> = .007), and CRP (<i>p</i> = .013) independently predicted mortality. Kaplan-Meier analysis showed higher HALP scores linked to lower long-term mortality (Log-rank: 20.102, <i>p</i> < .001), with an average follow-up of 48 ± 18 months.ConclusionThe HALP score emerged as a robust predictor of PAD prognosis, surpassing individual components and other parameters. Lower HALP scores correlated with more severe lesions and reduced life expectancy.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251327000"},"PeriodicalIF":1.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616675","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":"The systemic immune-inflammation index is an independent predictive factor in predicting major amputation in chronic limb-threatening ischemia.","authors":"Ahmet Can Çakmak, Mehmet Bülent Vatan, Betul Sarıbıyık Çakmak, Alper Erkin, Ersan Tatlı, Ibrahim Kocayigit","doi":"10.1177/17085381251327174","DOIUrl":"https://doi.org/10.1177/17085381251327174","url":null,"abstract":"<p><p>BackgroundLower extremity peripheral arterial disease (LEAD) is characterized by the narrowing and occlusion of arteries in the lower extremities. The most severe form of LEAD is chronic limb-threatening ischemia (CLTI), which carries a poorer prognosis for major amputation. The systemic immune-inflammation index (SII) is an index developed to simultaneously reflect the inflammatory and immunothrombosis status of patients, based on platelet counts and the neutrophil-to-lymphocyte ratio.ObjectiveOur study aimed to investigate the relationship between elevated SII and major limb amputation.MethodThe study included 140 patients with foot wounds (Rutherford 5 or 6) due to LEAD who were scheduled for endovascular intervention between 2018 and 2023. Major amputation was required in 27 patients (19.2%). The neutrophil-to-lymphocyte ratio (2.1/2.8/3.8 vs 3.8/6.6/9.3, <i>p</i> < .001), platelet-to-lymphocyte ratio (103.8/128.8/162.9 vs 132.8/212.3/314.6, <i>p</i> < .001), and SII (527/720/1055.5 vs 1108/1951/3807, <i>p</i> < .001) were higher in the major amputation group. ROC curve analysis determined that the optimal cut-off value for SII to predict major amputation in LEAD patients was 1018, with a sensitivity and specificity of 81% and 73%, respectively (AUC: 0.84, 95% CI: 0.74-0.92, <i>p</i> < .001). Logistic regression analysis showed that high SII (OR = 1.001, 95% CI = 1-1.001, <i>p</i> = .009) was identified as an independent predictor of major amputation in LEAD patients.ConclusionThis study establishes that a high SII value is associated with major amputation in LEAD patients with foot wounds.ResultSII is a valuable and straightforward parameter for predicting major amputation risk and guiding treatment decisions in LEAD patients.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251327174"},"PeriodicalIF":1.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626235","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":"Coils associated with micro vascular plug system for closing larger vessels: Technical note on a preliminary experience.","authors":"Fabio Salvatori, Cinzia Mincarelli, Paola Piccinni, Salvatore Alborino","doi":"10.1177/17085381251326997","DOIUrl":"https://doi.org/10.1177/17085381251326997","url":null,"abstract":"<p><p>ObjectivesThe MVP™ Micro Vascular Plug System represents a plug indicated for embolisation of peripheral vasculature. It has a lower profile and can be deliverable through smaller catheters, but it can occlude vessels ≤9 mm. We propose a new embolisation technique based on the use of the MVP™ and detachable coils to embolise vessels of larger calibre.Materials and methodsThrough a 7-F sheath the plug is implanted without detaching it. Then, the vessel is navigated in parallel with a microcatheter through which some coils are detached using the bare portion of the MVP™ to anchor them. This will stabilise the plug avoiding its distal migration. We performed vessel embolisation using this technique in two patients.ResultsTechnical success was 100% with no complications. No MPV™ migration was observed after one month.ConclusionsIn selected cases, this technique allows to expand the indications of the MVP™ when it is undersized to the calibre of the vessel.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251326997"},"PeriodicalIF":1.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626163","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 femoropopliteal arterial lesions with excimer laser atherectomy and drug-coated balloon.","authors":"Zhijie Liao, Jinbao Qin, Linbo Liu, Heng Zhang, Qi Tang, Wentao Liu, Minyi Yin, Xinwu Lu, Yi Zhang","doi":"10.1177/17085381251326331","DOIUrl":"https://doi.org/10.1177/17085381251326331","url":null,"abstract":"<p><p>ObjectivesProximal to mid-term effects of contrast excimer laser atherectomy (ELA) + drug-coated balloon (DCB) versus PTA + drug-coated balloon (DCB) in the treatment of new lesions in the femoral popliteal segment of patients with lower extremity arteriosclerosis and occlusion.MethodsThe clinical data of 105 patients with CT-confirmed femoropopliteal segment lesions (Rutherford grades 3-6) were retrospectively analyzed. According to the computerized randomization method, 58 patients (44 males, mean 72.41 ± 10.58 years) were divided into group A ELA + DCB dilation and 47 patients (35 males, mean 73.83 ± 11.56 years) in group B PTA + DCB dilation. The clinical indexes mainly included the occurrence of Rutherford grade, freedom from target lesion revascularization rate (FTLR), ankle-brachial index (ABI), stage I survival rate, and postoperative complications before, 6 months, and 12 months after surgery and were compared between the two groups.ResultsThe treatment success rate was 100% in all patients. The Rutherford grading at 12 months after operation was significantly improved in both groups, but statistical analysis showed that the improvement was more significant in group A (87.93% vs 72.34%, <i>p</i> = 0.043); ABI (0.77 ± 0.22^abc vs 0.65 ± 0.10^abc, <i>p</i> = 0.001); FTLR (93.10% vs 78.72%, <i>p</i> = 0.031), respectively. First-stage patency rate (91.38% vs 74.47%, <i>p</i> < 0.001),; complications, and adverse events were not statistically significant between the two groups (<i>p</i> > 0.05).ConclusionsELA + DCB significantly improved the 1-year freedom from target lesion revascularization rate and stage 1 patency rate with no significant increase in complications or adverse events.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251326331"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606489","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":"Mid-term outcomes of the fenestration, branched stent-graft, and hybrid techniques in the treatment of thoracic aortic pathologies involving the left subclavian artery.","authors":"Dongsheng Cui, Xiang Li, Zhian Liang, Junhang Chen, Jiaxin Wang, Jiayin Guo, Bin Zhao, Shuaishuai Wang, Peng Li, Jiaxue Bi, Xiangchen Dai","doi":"10.1177/17085381241312468","DOIUrl":"https://doi.org/10.1177/17085381241312468","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the midterm outcomes of fenestration, branched stent-graft thoracic endovascular aortic repair, and hybrid procedures in treating aortic arch pathologies involving the left subclavian artery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected the clinical data from 144 patients with aortic arch pathologies involving and only involving the left subclavian artery (LSA) who underwent fenestration, branched stent-graft thoracic endovascular aortic repair, and hybrid procedures from November 2015 and December 2022 at a single center. Among the patients, 68 were treated by fenestration, 61 by branched stent-grafts, and 15 by hybrid surgery. The clinical data was retrospectively analyzed and compared. The primary outcome indicators included technical success and in-hospital mortality; others included the incidence of endoleaks, spinal cord ischemia, LSA patency, stent-related entry tear, aortic-related reintervention, operative time, blood loss, and aortic remodeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The technical success rate was 83.8%, 95.1%, and 100% (&lt;i&gt;p&lt;/i&gt; = .046), and the in-hospital mortality rate was 1.5% (&lt;i&gt;n&lt;/i&gt; = 1), 0%, and 0% (&lt;i&gt;p&lt;/i&gt; = 1.000) in the fenestration, branched stent-graft, and hybrid surgery groups. Type I or III endoleaks occurred in 16.2% (&lt;i&gt;n&lt;/i&gt; = 11), 4.9% (&lt;i&gt;n&lt;/i&gt; = 3), and 0% of patients, respectively (&lt;i&gt;p&lt;/i&gt; = .046). The operative time, blood loss, and hospitalization duration of the hybrid surgery group was significantly higher than those of the other two groups (&lt;i&gt;p&lt;/i&gt; &lt; .05). However, the surgery-related costs and total costs in the hybrid surgery group were lower than the other two groups (&lt;i&gt;p&lt;/i&gt; &lt; .001). The rate of LSA patency was 100% in the fenestration group and 98.3% in the branched stent-graft group (&lt;i&gt;p&lt;/i&gt; = .475). The all-cause mortality rates were 10.9% (&lt;i&gt;n&lt;/i&gt; = 7), 6.9% (&lt;i&gt;n&lt;/i&gt; = 4), and 0%, respectively (&lt;i&gt;p&lt;/i&gt; = .359). Spinal cord ischemia and other complications were not significantly different in each group, both in the perioperative and postoperative periods. In the subgroup analysis of patients with AD, the incidence of endoleaks was 28.9% (&lt;i&gt;n&lt;/i&gt; = 13), 7.0% (&lt;i&gt;n&lt;/i&gt; = 3), and 0%, respectively (&lt;i&gt;p&lt;/i&gt; = .011), and stent-related new entry tears in each group were 2.2% (&lt;i&gt;n&lt;/i&gt; = 1), 18.6% (&lt;i&gt;n&lt;/i&gt; = 8), and 14.3% (&lt;i&gt;n&lt;/i&gt; = 1), respectively, &lt;i&gt;p&lt;/i&gt; = .032. The overall cumulative survival rate at 2 years was 90.0%, 92.4%, and 100%, respectively (&lt;i&gt;p&lt;/i&gt; = .508). The true lumen area of the aortic arch and descending thoracic aorta in the stent segment was significantly larger postoperatively compared to that preoperatively in both of these three groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The fenestration technique is sophisticated with long learning curve and is prone to complications such as endoleaks with inexperience. Branched grafts are at greater risk of stent-related entry tears, which result in a higher rate of re-intervention. ","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241312468"},"PeriodicalIF":1.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483630","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}