Vascular最新文献

{"title":"Comparative outcomes of surgical and conservative management in carotid artery dissection.","authors":"Yuyao Feng, Zhan Zhu, Jiang Shao, Kang Li, Yiyun Xie, Lizhi Xie, Yuru Wang, Lin Wang, Huanyu Dai, Zhichao Lai, Bao Liu","doi":"10.1177/17085381241289815","DOIUrl":"10.1177/17085381241289815","url":null,"abstract":"<p><strong>Objectives: </strong>Carotid artery dissection (CAD) is a significant cause of strokes in young individuals, leading to severe complications and socioeconomic burdens. Despite antithrombotic therapy being the primary management strategy, optimal treatment for patients with recurrent or worsening symptoms remains undefined. This study aims to describe the characteristics and evaluate the outcomes of conservative versus surgical management in CAD patients.</p><p><strong>Methods: </strong>A total of 23 patients presenting with CAD from November 2014 to December 2021 were reviewed retrospectively. Patient demographics, vascular risk factors, symptoms, imaging results, treatment details, and follow-up information were collected and analyzed. Propensity score matching (PSM) was utilized to enhance comparability.</p><p><strong>Results: </strong>The mean age of the patients was 46.4 ± 9.4 years, with a median follow-up of 12 (range 3-90) months. Of the 23 patients reviewed, seven underwent endovascular treatment or open surgery due to unresponsiveness to conservative therapy, while 16 received conservative management. All patients showed regression of symptoms. Surgical patients showed a significant improvement with a 100% patency rate during the follow-up. PS matching adjusted for baseline differences, yielding comparable groups for analysis. No significant difference between treatment approaches was observed in stroke recurrence rates, although surgical intervention showed promising outcomes in symptom resolution and stroke prevention.</p><p><strong>Conclusion: </strong>Both conservative and surgical management of CAD can lead to favorable outcomes. While conservative therapy remains the initial approach and proves effective, surgery appears beneficial and safe in certain cases unresponsive to conservative treatment. Further investigation through larger prospective and randomized trials is necessary to establish its safety and efficacy.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378367","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":"Embolization of a ruptured cystic artery pseudoaneurysm by percutaneous injection.","authors":"Fatih Hakan Tufanoğlu, Behiç Akyüz","doi":"10.1177/17085381241289821","DOIUrl":"https://doi.org/10.1177/17085381241289821","url":null,"abstract":"<p><strong>Background: </strong>Pseudoaneurysm of the cystic artery is very rare. It usually presents with rupture and hemorrhagic shock, which may be life-threatening. Ultrasonography and contrast-enhanced tomography can be used for the diagnosis. The mainstay of treatment for this disease is cholecystectomy.</p><p><strong>Objective: </strong>Here we present an 86-year-old man with known diabetes and Alzheimer's disease whose pseudoaneurysm was treated with percutaneous thrombin injection and highlight the technical aspect of the procedure.</p><p><strong>Method: </strong>With ultrasonography guidance, a 21-gauge Chiba needle was passed through the liver and advanced into the pseudoaneurysm sac. A controlled, slow injection of 0.5-cc thrombin into the sac was performed with instant occlusion. Doppler imaging performed immediately following the procedure revealed that the pseudoaneurysm was not filled.</p><p><strong>Conclusion: </strong>Pseudoaneurysm of the gallbladder is extremely rare, and its diagnosis is difficult. If the condition is not treated right away, it can quickly become life-threatening. The majority of the pseudoaneurysms have already ruptured, and the patients are clinically septic, making surgery dangerous. Also, the use of contrast media in these patients may increase the risk of nephropathy, which is not an issue with percutaneous injection. Due to the obvious risk of rupture and bleeding, we propose injecting pseudoaneurysms only if they have a visible wall.</p><p><strong>Result: </strong>Percutaneous injection of the gallbladder pseudoaneurysms can be an option when treating gallbladder pseudoaneurysms. More research on long-term success rates is required.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376106","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":"Physician-modified funnel-shaped covered stent for selective false lumen exclusion in chronic type B aortic dissection.","authors":"Lorenzo Torri, Petroula Nana, Giuseppe Panuccio, José Ignacio Torrealba, Daour Yousef El Sarhan, Tilo Kölbel","doi":"10.1177/17085381241289811","DOIUrl":"https://doi.org/10.1177/17085381241289811","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the technique of off-centering a balloon-expandable covered stent for selective occlusion of a distal entry tear (ET) in a patient, conservatively treated for chronic type B aortic dissection (cTBAD), presenting FL expansion.</p><p><strong>Technique: </strong>A 63-year-old male, with conservatively managed cTBAD, presented at follow-up with FL partial thrombosis and expansion (thoracic aorta FL from 21 mm to 27 mm and abdominal aorta FL from 11 mm to 15 mm in 6 months). No proximal ET was identifiable. Distal FL perfusion was caused by an ET in the abdominal aorta feeding a 2 mm accessory renal artery (ARA). As the aortic diameter was below the threshold for endovascular repair, a selective occlusion of the distal ET and ARA was planned. A balloon-expandable covered stent was modified by off-centering the covered stent proximally and resulting in a funnel-shape occluder after deployment across the ET into the ARA. To prevent type Ic endoleak due to possible FL expansion caused by an intra-operatively detected phrenic artery (PA), coils were deployed into the lumen of the modified stent and the ARA. The pre-discharge computed tomography angiography showed exclusion of both the ARA and ET and a type 2 endoleak from the PA.</p><p><strong>Conclusion: </strong>A balloon-expandable covered stent can be modified by off-centering the covered stent resulting in a funnel shape to adapt to different diameter requirements.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373001","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":"A systematic review and meta-analysis of outcomes associated with development of surgical site infection after lower-limb revascularization surgery.","authors":"Aidan M Kirkham, Jasmine Candeliere, Sudhir K Nagpal, Henry T Stelfox, Dalibor Kubelik, George Hajjar, Derek R MacFadden, Daniel I McIsaac, Derek J Roberts","doi":"10.1177/17085381241290039","DOIUrl":"https://doi.org/10.1177/17085381241290039","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Although surgical site infection (SSI) is a commonly used quality metric after lower-limb revascularization surgery, outcomes associated with development of this complication are poorly characterized. We conducted a systematic review and meta-analysis of studies reporting associations between development of an SSI after these procedures and clinical outcomes and healthcare resource use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, Embase, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 4th, 2023) for studies examining adjusted associations between development of an SSI after lower-limb revascularization surgery and clinical outcomes and healthcare resource use. Two investigators independently screened abstracts and full-text citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Heterogeneity was assessed using I&lt;sup&gt;2&lt;/sup&gt; statistics. GRADE was used to assess estimate certainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 6671 citations identified, we included 11 studies (n = 61,628 total patients) that reported adjusted-associations between development of an SSI and 13 different outcomes. Developing an SSI was associated with an increased adjusted-risk of hospital readmission (pooled adjusted-risk ratio (aRR) = 3.55; 95% CI (confidence interval) = 1.40-8.97; n = 4 studies; n = 13,532 patients; I&lt;sup&gt;2&lt;/sup&gt; = 99.0%; moderate certainty), bypass graft thrombosis within 30-days (pooled aRR = 2.09; 95% CI = 1.41-3.09; n = 2 studies; n = 23,240 patients; I&lt;sup&gt;2&lt;/sup&gt; = 51.1%; low certainty), reoperation (pooled aRR = 2.69; 95% CI = 2.67-2.72; n = 2 studies; n = 23,240 patients; I&lt;sup&gt;2&lt;/sup&gt; = 0.0%; moderate certainty), bleeding requiring a transfusion or secondary procedure (aRR = 1.40; 95% CI = 1.26-1.55; n = 1 study; n = 10,910 patients; low certainty), myocardial infarction or stroke (aRR = 1.21; 95% CI = 1.02-1.43; n = 1 study; n = 10,910 patients; low certainty), and major (i.e., above-ankle) amputation (pooled aRR = 1.93; 95% CI = 1.26-2.95; n = 4 studies; n = 32,859 patients; I&lt;sup&gt;2&lt;/sup&gt; = 83.0; low certainty). Development of an SSI &gt;30-days after the index operation (aRR = 2.20; 95% CI = 1.16-4.17; n = 3 studies; n = 21,949 patients; low certainty) and prosthetic graft infection (aRR = 6.72; 95% CI = 3.21-12.70; n = 1 study; n = 272 patients; low certainty) were both associated with an increased adjusted-risk of major amputation. Prosthetic graft infection was also associated with an increased adjusted-risk of mortality &gt;30-days after the index procedure (aRR = 6.40; 95% CI = 3.32-12.36; n = 1 study; n = 272 patients; low certainty).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This systematic review and meta-analysis suggests that development of an SSI after lower-limb revascularization surgery significantly increases patient morbidity and healthcare resource use. SSI is therefore a valuable quality metric after these surgeries. However, current esti","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373000","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":"Malnutrition is associated with adverse 30-day outcomes after endovascular repair of abdominal aortic aneurysm.","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1177/17085381241289484","DOIUrl":"https://doi.org/10.1177/17085381241289484","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is particularly pertinent in patients undergoing vascular surgery, who frequently present with a high burden of comorbidities and advanced age that can impede nutrient absorption. While previous studies have established that vascular surgery patients with malnutrition had poorer outcomes, the impact of nutritional status in patients undergoing endovascular aneurysm repair (EVAR) has not yet been investigated. Therefore, this study aimed to assess the effect of malnutrition on 30-day outcomes following non-ruptured EVAR.</p><p><strong>Methods: </strong>Patients who had infrarenal EVAR were identified in the ACS-NSQIP targeted database from 2012-2022. Exclusion criteria included age less than 18 years, ruptured aneurysm, and emergency. Malnutrition was defined as patients with preoperative weight loss of greater than 10% decrease in body weight in the 6 months immediately preceding the surgery. A 1:5 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without malnutrition. Thirty-day postoperative outcomes were examined.</p><p><strong>Results: </strong>There were 154 (0.94%) patients with malnutrition who went under non-ruptured EVAR. Meanwhile, 16,309 patients without malnutrition went under intact EVAR, where 737 of them were matched to all malnutrition patients. Malnourished patients had more comorbidity burdens. After propensity-score matching, patients with malnutrition had elevated but non-significant 30-day mortality (5.92% vs 2.99%, <i>p</i> = .09). However, malnutrition patients had higher risks of renal complications (2.63% vs 0.68%, <i>p</i> = .04), bleeding requiring transfusion (22.37% vs 14.38%, <i>p</i> = .02), and unplanned reoperation (11.18% vs 4.88%, <i>p</i> = .01), as well as longer length of stay (6.11 ± 7.91 vs 4.44 ± 6.22 days, <i>p</i> < .02).</p><p><strong>Conclusion: </strong>Patients with malnutrition experienced higher rates of morbidity after non-ruptured EVAR. Targeting malnutrition could be a strategy for preventing complications after EVAR and proper preoperative malnutritional management could be warranted.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354777","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":"Revascularization of superior mesenteric artery occlusion via the arc of Buhler: A case report and literature review.","authors":"Wei Huang, Ke Wang, Yang Liu, Qi-Qi Wang, Hai-Jun Wei, Chun-Shui He","doi":"10.1177/17085381241289485","DOIUrl":"https://doi.org/10.1177/17085381241289485","url":null,"abstract":"<p><strong>Background: </strong>To report revascularization of a superior mesenteric artery (SMA) ostial occlusion via the Arc of Buhler.</p><p><strong>Case report: </strong>A 62-year-old female presented with 2 months of recurrent abdominal distension and postprandial pain. Computed tomography angiography (CTA) revealed ostial occlusion of the SMA with distal perfusion via the Arc of Buhler (connecting the celiac trunk and SMA). Conventional endovascular techniques failed. A 0.014 guidewire was passed retrograde through the occlusion via the Arc of Buhler. The guidewire was captured from the femoral sheath and balloon angioplasty with stent placement was performed. The patient had complete symptom resolution post-procedure.</p><p><strong>Conclusions: </strong>Retrograde revascularization via the Arc of Buhler is an effective method for treating the initial segment occlusion of the SMA.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354778","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":"Endovascular solutions for symptomatic free-floating thrombus in thoracic aorta in rheumatoid arthritis patients: Two clinical cases.","authors":"G Mastrangelo, P Di Sebastiano, V Palazzo","doi":"10.1177/17085381241269747","DOIUrl":"https://doi.org/10.1177/17085381241269747","url":null,"abstract":"<p><strong>Objectives: </strong>We present two clinical cases of association between symptomatic free-floating thrombus (FFT) in thoracic aorta and rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>In the first patient, we observed a recent onset of peripheral and visceral signs of embolization: after a first treatment with anticoagulation, our Aortic team scheduled the coverage of FFT (sited in zone 1 of the aortic arch) with an anatomical debranching of anonymous trunk and left carotid artery, a left carotid-subclavian bypass, and a TEVAR of the aortic arch with proximal landing in zone 0 of the arch. The second case was characterized by chest pain, left upper limb ischemia, and CTA evidence of an FFT in zone 3 of the aortic arch; we planned a chimney-TEVAR on the left subclavian artery and descending thoracic aorta (with proximal landing in zone 2 of the aortic arch) to exclude the FFT.</p><p><strong>Results: </strong>No complications resulted and no new embolic episodes were registered.</p><p><strong>Conclusions: </strong>Evaluating the aorta is warranted in all patients with peripheral emboli of uncertain pathogenesis. In our opinion, the endovascular treatment of a symptomatic FFT could represent an effective and safe solution in a patient fit for endovascular surgery, but larger studies are required to define a personalized treatment strategy.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296644","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":"Anatomical variations of origin of the internal carotid artery: Report of two cases and systematic review of the literature","authors":"Lucia Ramputi, Daniela Mazzaccaro, Karima Tissir, Manuel Bruno Trevisan, Gianluca Conte, Giovanni Nano, Lorenzo Menicanti, Serenella Castelvecchio","doi":"10.1177/17085381241283095","DOIUrl":"https://doi.org/10.1177/17085381241283095","url":null,"abstract":"BackgroundAnatomical variations of origin of the internal carotid artery (ICA) are very uncommon and may pose a diagnostic and therapeutic challenge.ObjectiveWe report a case of direct origin of the right ICA from the innominate artery (aplasia of common carotid artery) and a case of duplication of right ICA in healthy patients who performed duplex ultrasound (DUS) for primary cardiovascular prevention screening.MethodsIn both cases, the ultrasound scan was performed both in a transverse plane and on the longitudinal axis, and in one of the two cases, a computed tomography angiography was performed to confirm the diagnosis. A review of the current literature about anatomical variations of origin of carotid arteries was also performed.ResultsThe most frequent congenital anomaly is represented by the aplasia of the CCA, followed by the agenesis and by the duplication of the ICA. In most cases, the anomaly is discovered occasionally and symptoms are aspecific. Diagnosis is usually confirmed through a multimodality imaging approach, including DUS of extracranial carotid arteries, magnetic resonance imaging (MRI), and computed tomographic angiography. In most cases, treatment was conservative, with pharmacological therapy aimed at the symptoms.ConclusionThe recognition of such variations is mandatory, particularly when the patient needs a surgical treatment that may involve the vessel with the anatomical variations.","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260626","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":"Can wound blush be used as an indicator for termination of endovascular procedures in chronic limb-threatening ischemia patients?","authors":"Mohammed Shahat, Ashraf G Taha, Ashraf Elnaggar, Hesham Aboloyoun","doi":"10.1177/17085381241283096","DOIUrl":"https://doi.org/10.1177/17085381241283096","url":null,"abstract":"IntroductionPredicting the outcomes of endovascular revascularization of chronic limb-threatening ischemia (CLTI) patients with foot wounds can be challenging. Angiographic wound blush (WB) assessment has been found to be a helpful tool to assess wound perfusion. The aim of this study is to evaluate WB during endovascular revascularization of CLTI patients and its effects on treatment outcomes.MethodsThis prospective study included all CLTI patients with foot wounds who underwent successful endovascular revascularization of infrainguinal arterial disease between 2019 and 2021. Patients were grouped according to the WB status into positive WB (group A) and negative WB (group B). Both groups were compared for demographics, comorbidities, clinical picture, and 12-month limb-based patency (LBP) and amputation-free survival (AFS) rates.ResultsThe study included 69 patients of Rutherford classes 5 (46.4%) and 6 (53.6%), with the main arterial lesion located at the femoropopliteal (58%) or infrapopliteal (42%) segments. Completion angiography showed positive WB in 38 (55.1%) patients and negative WB in 31 (44.9%) patients. Both groups were comparable regarding patient presentation, site of the main arterial lesion, and distribution of foot lesions in relation to the feeding artery. The overall 12-month LBP and AFS rates were 21.7% and 39.1%, respectively, with significantly better rates in group A than in group B (LBP, 31.6% vs 9.7%, p = 0.001 and AFS, 54.1% vs 22.2%, p = 0.006, respectively). Successful angiosome-based direct flow to the foot was achieved in 38 patients (55.1%), resulting in significantly better 12-month AFS rates than those with indirect revascularization (54.8% vs 26.3%, p = 0.036, respectively), despite the comparable 12-LBP rates between the direct and indirect revascularization groups (29% vs 15.8%, p = 0.133, respectively). Multivariate logistic regression analysis identified smoking as a significant predictor of a major amputation, whereas positive WB and successful direct revascularization were significant predictors of limb salvage.ConclusionsWB can serve as a predictor for AFS and LBP during endovascular revascularization of CLTI patients with foot wounds. A positive WB may guide the decision to conclude an endovascular procedure, potentially avoiding unnecessary complicated maneuvers to recanalize more vessels. Conversely, a negative WB may suggest the need for further revascularization attempts to augment wound perfusion and healing.","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187432","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":"Systematic review of clinical guidelines and consensus statements concerning heparin and protamine dosing and monitoring of anticoagulation levels for non-cardiac arterial procedures.","authors":"Liliane C Roosendaal,Orkun Doganer,Arno M Wiersema,Jan D Blankensteijn,Vincent Jongkind","doi":"10.1177/17085381241283519","DOIUrl":"https://doi.org/10.1177/17085381241283519","url":null,"abstract":"OBJECTIVESThis systematic review was performed to examine all published practice Guidelines and Consensus Statements (together: GCS) on heparin dosing and monitoring during non-cardiac arterial procedures (NCAP). The objective was to scrutinize the recommendations and advice outlined within these GCS documents and to evaluate the supporting evidence for these recommendations. Additionally, the use of the activated clotting time (ACT) and target ACT values were explored.METHODSThis systematic review was performed in accordance with the PRISMA Guidelines. Medline and Embase databases were searched to identify all GCSs in the English language on NCAP. The final literature search was performed in January 2023. This search was supplemented by searching websites of relevant professional vascular surgical organizations for GCSs. Titles and abstracts were assessed by two independent reviewers.RESULTSOf 9716 titles identified, 27 GCSs met the predefined inclusion criteria: six GCSs regarding carotid intervention, seven regarding procedures for aneurysmal disease of the abdominal aorta and iliac arteries, 12 regarding interventions for acute and chronic peripheral arterial occlusive disease and two regarding open and endovascular interventions of thoraco-abdominal aortic aneurysms. Administration of heparin is advised for al NCAP. There was high variability concerning heparin dose: both standard dose as weight based dosing (30-150 IU/kg) was advised. Recommendations on repeated doses, ACT monitoring and heparin reversal using protamine also varied widely. In none of the GCSs, the type of the ACT measuring device or used cartridges were specified.CONCLUSIONSLarge variability was found between the included GCSs with regard to the recommendations on heparin dose and target ACT values during NCAP. Advice and recommendations in GCSs were based on low-quality studies or without providing any reference at all. The described variability in recommendations emphasizes the need for large prospective (randomized) studies or the incorporation of data on heparin and the use of ACT monitoring into verified vascular surgery registries, to develop evidence-based, practical and uniform applicable recommendations.","PeriodicalId":23549,"journal":{"name":"Vascular","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187429","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}