Vascular最新文献

{"title":"Endovascular abdominal aortic aneurysm repair (EVAR) outcomes of unibody and single/double docking limb endografts in Medicare beneficiaries between 2012 and 2018.","authors":"Mark F Conrad, Ami Sood, Alex O'Brien, Sapna Prasad, Erik Zendejas, Matt Thompson","doi":"10.1177/17085381241300131","DOIUrl":"https://doi.org/10.1177/17085381241300131","url":null,"abstract":"<p><strong>Objective: </strong>The evaluation of perioperative and long term outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) using anatomic (unibody) and proximal neck fixated (docking limbs) endografts across consecutive time cohorts.</p><p><strong>Design: </strong>This study compares the outcomes of EVAR in Medicare patients stratified by mode of fixation.</p><p><strong>Methods: </strong>All patients who underwent EVAR between 2012 and 2018 were identified in the Medicare database. Anatomic fixation (AF) and proximal fixation (PF) grafts were differentiated using Current Procedural Terminology (CPT) codes. The AF population was divided into three-time cohorts based on iterative changes in graft design: Cohort 1: (01/01/2012-20/07/2014); Cohort 2: (21/07/2014-09/05/2016); and Cohort 3: (10/05/2016-31/12/2017). The PF cohort was similarly divided into these three periods. Outcomes were evaluated through 31/12/2020 and included all-cause mortality, aortic rupture, and aortic-related reintervention.</p><p><strong>Results: </strong>32,031 patients underwent EVAR during the study period; 4729 were AF and 27,302 were PF. There were more women (<i>p</i> < .001) and patients with peripheral vascular disease (PVD) (<i>p</i> < .001) in the AF group. There were no group differences in perioperative outcomes. In Cohort 1, there was a higher rate of reintervention (11.9% vs 7.6%; <i>p</i> < .001) and aortic rupture (5.3% vs 4.0%; <i>p</i> = .019) in the AF group compared to the PF group. In Cohort 2, reintervention, aortic rupture, and reintervention rates were similar between the two groups (p = NS). In Cohort 3, the reintervention and aortic rupture rates were similar between the two groups (p = NS).</p><p><strong>Conclusion: </strong>The higher rates of aortic rupture and reintervention seen in the AF group in Cohort 1 when compared with the PF group did not persist in Cohorts 2 and 3. This suggests that improvements in graft design may have led to durability which is similar to that of PF grafts. However, late aneurysm related complications are inherent risks after EVAR and long-term surveillance remains necessary.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241300131"},"PeriodicalIF":1.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629070","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":"Giant renal artery aneurysm with severe compression of the right kidney.","authors":"Haibo Wang, Mingwei Wu, Jiang Xiong","doi":"10.1177/17085381241299190","DOIUrl":"https://doi.org/10.1177/17085381241299190","url":null,"abstract":"<p><strong>Objectives: </strong>Renal artery aneurysm (RAA) is a rare condition among visceral aneurysms, often asymptomatic and incidentally discovered through imaging. Surgical or interventional procedures are utilized for treatment, depending on the aneurysm's size, morphology, and the patient's physical condition, to prevent rupture.</p><p><strong>Methods: </strong>A patient was admitted with a giant asymptomatic RAA, measuring a maximum diameter of 11 cm on a serendipitous occasion.</p><p><strong>Results: </strong>We successfully accomplished a full embolization treatment for the aneurysm, exclusively utilizing inflow tract embolization techniques. Six months post-treatment, a follow-up abdominal ultrasound examination demonstrated a notable decrease in the aneurysm's diameter, signifying the positive outcome of our intervention.</p><p><strong>Conclusions: </strong>This approach offers a feasible alternative in challenging cases, especially when traditional surgical methods are not feasible or carry significant risks.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241299190"},"PeriodicalIF":1.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606643","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":"Thirty-day outcomes of endovascular repair of Stanford type B aortic dissection in patients with chronic obstructive pulmonary disease.","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1177/17085381241298732","DOIUrl":"https://doi.org/10.1177/17085381241298732","url":null,"abstract":"<p><strong>Background: </strong>Thoracic Endovascular Aortic Repair (TEVAR) has revolutionized the surgical treatment for Stanford type B aortic dissection (TBAD). While chronic obstructive pulmonary disease (COPD) is associated with worse outcomes in major surgeries, the specific outcomes of TEVAR in patients with COPD have not been extensively explored. This study aimed to evaluate the 30-day postoperative outcomes of COPD patients undergoing TEVAR for TBAD utilizing data from a multi-institutional national registry.</p><p><strong>Methods: </strong>Patients who underwent TEVAR for TBAD were identified in the ACS-NSQIP database from 2005 to 2022. A 1:3 propensity-score matching was used to match demographics and preoperative characteristics between patients with and without COPD. Thirty-day postoperative outcomes were compared.</p><p><strong>Results: </strong>There were 172 (9.56%) and 1628 (90.44%) COPD and non-COPD patients who underwent TEVAR for TBAD, respectively. Patients with COPD had a higher comorbidity burden. After the propensity-score matching, all 172 COPD patients were matched to 440 non-COPD patients. COPD and non-COPD patients had comparable mortality rates (10.12% vs 6.82%, <i>p</i> = .18). However, COPD patients had a higher risk of pulmonary complications (20.83% vs 13.18%, <i>p</i> = .02). All other 30-day outcomes were similar between the two groups.</p><p><strong>Conclusion: </strong>COPD patients had 58.04% higher pulmonary complications while all other 30-day outcomes were comparable to their non-COPD counterparts. Therefore, close monitoring and timely intervention for pulmonary complications in COPD patients can be important after TEVAR for TBAD. Future studies should investigate long-term outcomes among these COPD patients.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241298732"},"PeriodicalIF":1.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584414","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":"5-years patency results of Zilver PTX on the femoro-popliteal arterial segment: A Northern Sydney experience.","authors":"Erin C Saricilar, Naomi Anning, Raleene Gatmaitan, Kiraati Patel, Charles Fisher, Vikram Puttaswamy","doi":"10.1177/17085381241297765","DOIUrl":"https://doi.org/10.1177/17085381241297765","url":null,"abstract":"<p><strong>Background: </strong>The burden of peripheral arterial disease is increasing. Treatment of femoro-popliteal lesions remains challenging despite novel endovascular devices. Drug-eluting stents suppress post-treatment inflammation and reducing neo-intimal hyperplasia to reduce in-stent restenosis.</p><p><strong>Methods: </strong>A multi-centre retrospective 5-years longitudinal study was undertaken to evaluate freedom from clinically driven target limb revascularisation (FF CD-TLR) and patency of Zilver PTX stents in treating symptomatic femoro-popliteal stenotic lesions. Kaplan-Meier survival curves were used to demonstrate FF CD-TLR, primary, primary assisted and secondary patency.</p><p><strong>Results: </strong>There were 148 patients and 183 lesions treated with a mean age of 80.3 years and 52% males. The all-cause 5-years mortality was 25%. FF CD-TLR yearly patencies to 5 years were 81%, 67%, 62%, 57% and 52%, respectively, with significantly poorer outcomes for in-stent restenosis, longer stent lengths and lesions at the femoro-popliteal junction. Primary patencies were 63%, 47%, 40%, 34% and 24%, assisted primary patencies were 90%, 75%, 68%, 59% and 48% and secondary patencies were 96%, 94%, 94%, 92% and 92%. Major adverse limb events were 5% at 1-year and cumulative at 5-years was 16%.</p><p><strong>Discussion: </strong>The clinical outcomes in this study population are comparable to recent publications with smaller cohorts. Our study confirms Zilver PTX has very good primary patency over 5 years with no discernible effect on all-cause mortality in an elderly cohort with particularly long treated lesions. Our results are similar to those seen in younger patients with shorter lesions. Nonetheless, longer lesions required more reinterventions to maintain patency.</p><p><strong>Conclusion: </strong>Zilver PTX is a safe and durable drug-eluting stent when utilised in the management of femoro-popliteal stenotic lesions with good long-term patency and limited need for re-intervention.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241297765"},"PeriodicalIF":1.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564897","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":"Long-term results of carotid body tumours surgery and predictive analytics on metastatic disease and recurrence.","authors":"Najibullah I Verdikhanov, Andrey V Chupin, Irina E Timina, Zaurbek A Adyrkhaev","doi":"10.1177/17085381241297067","DOIUrl":"https://doi.org/10.1177/17085381241297067","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The determination of clinico-surgical predictors of carotid body tumour (CBT) metastasizing and/or recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with CBT but without a history of its previous treatment who had received inpatient medical aid at a tertiary surgical centre during the period 2011-2021 were retrospectively reviewed to obtain baseline data. Primary endpoints of the study were CBT metastasizing and/or local recurrence after radical surgery (composite endpoint) and overall survival. Secondary endpoint of the study was primary patency of carotid arteries that had been repaired/reconstructed as a result of CBT removal. Suspected predictors of CBT metastasizing/recurrence were young age of CBT onset, positive family history, multifocal paraganglioma, Shamblin type III CBT, carotid bifurcation and/or internal carotid artery (ICA) reconstruction as a result of CBT excision. To detect CBT metastasizing/recurrence, prospective imaging-based whole-body screening was suggested to patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-three patients met the eligibility criteria. The overall survival rate was 100% at a median follow-up time of 68 months (interquartile range [IQR] 27‒104.5 months). The primary patency of repaired carotid arteries (&lt;i&gt;n&lt;/i&gt; = 9) was 88.9% at a median follow-up time of 99 months (IQR 15.5‒116.5 months). Thirty-nine patients underwent the prospective whole-body screening. Eight (20.5%) patients were diagnosed with metastatic disease (&lt;i&gt;n&lt;/i&gt; = 6) or local recurrence (&lt;i&gt;n&lt;/i&gt; = 2). Patients with CBT metastasizing/recurrence were younger at age of CBT onset (&lt;i&gt;p&lt;/i&gt; = .011), more frequently had Shamblin type III CBT (&lt;i&gt;p&lt;/i&gt; = .004) and the necessity for carotid artery repair/reconstruction (&lt;i&gt;p&lt;/i&gt; = .041) than patients without metastasizing/recurrence. These two groups were similar in terms of gender (&lt;i&gt;p&lt;/i&gt; = .682), the prevalence of multifocal paraganglioma (&lt;i&gt;p&lt;/i&gt; = .167) and positive family history (&lt;i&gt;p&lt;/i&gt; = .180). Only the belonging of a CBT to Shamblin type III was defined as a statistically significant predictor of CBT metastasizing/recurrence in both univariable and multivariable binary logistic regression analyses (odds ratio 30; 95% confidence interval: 2.649-339.739; &lt;i&gt;p&lt;/i&gt; = .006 and odds ratio 75.409; 95% confidence interval: 1.082-5254.557; &lt;i&gt;p&lt;/i&gt; = .046, respectively). Multifocal paraganglioma as a predictor exhibited a strong tendency towards statistical significance (&lt;i&gt;p&lt;/i&gt; = .09 and &lt;i&gt;p&lt;/i&gt; = .072, respectively). Other suspected predictors didn't reach the level of statistical significance either in univariable (&lt;i&gt;p&lt;/i&gt; = .151 for positive family history) or in multivariable (&lt;i&gt;p&lt;/i&gt; = .211 for age of CBT onset; &lt;i&gt;p&lt;/i&gt; = .734 for carotid artery reconstruction/repair) binary logistic regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Shamblin type III CBT has high potential for metastasizing and recurrence. Patients with Shamblin type III CBT an","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241297067"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564903","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":"Comparative analysis of negative pressure wound therapy (PICO) and standard dressing application after arterial vascular reconstructions.","authors":"Valentyna Kostiuk, Soraya Fereydooni, Ocean Setia, Sarah A Loh, David Strosberg, Britt H Tonnessen, Cassius Iyad Ochoa Chaar, Edouard Aboian","doi":"10.1177/17085381241296606","DOIUrl":"https://doi.org/10.1177/17085381241296606","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infections following arterial reconstructions with femoral exposures are common and potentially preventable. Negative pressure wound therapy has emerged as a potential solution to minimize groin wound complications. Our study evaluates efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions.</p><p><strong>Methods: </strong>A retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and June 2023. Patients were divided into two groups: patients treated with PICO device and patients who received standard dressing (non-PICO). Patient demographics, comorbidities, vascular evaluation, and procedure indications were compared. Previous interventions, incision orientation and procedure types were noted. The wound complication categories were graded according to the Szilagyi classification: grade 1 (superficial infection/minor dehiscence), grade 2 (deep infection/major dehiscence), and grade 3 (artery or prosthetic involvement). Statistical significance level was determined at <i>p</i> < .05 for all analyses.</p><p><strong>Results: </strong>A total of 217 groin dissections in 184 patients were analyzed with 132 and 85 groin dissections in the PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups in terms of age, sex, BMI, and procedure indications. Prior endovascular procedures and re-operative groin surgeries were more prevalent in the PICO group. The use of antibiotics post-operatively for groin wound complication was greater in the non-PICO group. The incidence of wound complications was higher in the non-PICO group (29.4% vs 10.6%, <i>p</i> < .001). Multivariate logistic regression analysis determined that PICO dressing as well as hybrid and endovascular index procedures were associated with lower risks of groin complications.</p><p><strong>Conclusion: </strong>PICO dressing decreased the incidence of groin wound complications in patients undergoing open vascular reconstructions. This study highlights the value of adjunctive negative pressure therapy in reduction of wound complications after arterial reconstructions in the inguinal region.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241296606"},"PeriodicalIF":1.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508964","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":"Extracranial internal carotid artery aneurysm: Surgical approach to a rare entity.","authors":"Didem Melis Oztas, Seckin Cobanoglu, Asli Cakir, Okan Kuguoglu, Emre Oteyaka, Murat Ugurlucan","doi":"10.1177/17085381241290634","DOIUrl":"https://doi.org/10.1177/17085381241290634","url":null,"abstract":"<p><strong>Background: </strong>Extracranial internal carotid artery aneurysms are rare entities that arise within the carotid triangle. Although rare, they are clinically significant due to the risk of neurologic thromboembolic events, compression of cranial nerves and vasculature, rupture, and ischemia.</p><p><strong>Objective: </strong>Surgery is the gold-standard treatment for symptomatic patients of all ages with extracranial internal carotid artery aneurysm.</p><p><strong>Method: </strong>A 26-year-old female patient was admitted to our institution with complaints of left auricular pain, hoarseness, and uncontrollable hypertension. She had a pulsatile mass located at the left cervical region. After diagnosing the extracranial internal carotid artery aneurysm, it was decided that surgery was necessary to relieve the patient's discomfort and prevent possible complications from the aneurysm in the left carotid artery.</p><p><strong>Result: </strong>In the operation, the aneurysmatic segment was resected and sent for histopathological evaluation. Saphenous vein graft was interposed as end to end anastomosis to the proximal and distal healthy segments of the internal carotid artery.</p><p><strong>Conclusion: </strong>This case report highlights the surgical management of a 26-year-old female patient who presented to our institution with complaints of left auricular pain, hoarseness, uncontrolled hypertension, and a pulsatile mass localized at the left cervical region and diagnosed extracranial internal carotid artery aneurysm.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241290634"},"PeriodicalIF":1.0,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475962","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":"Comparing anticoagulant therapy alone, anticoagulant therapy in combination with catheter-directed thrombolysis, and anticoagulant therapy in combination with pharmacomechanical catheter-directed thrombolysis in the patients with optional inferior vena cava filter-related thrombosis: A single-center retrospective study.","authors":"Zhaoyang Li, Zhicheng Duan, Huitang Yang, Meng Li, Yandong Cai, Zhan Jiang, Guoju Fan, Kaiqiang Wang, Bo Chen, Hongwei Zhang, Yankui Li","doi":"10.1177/17085381241289825","DOIUrl":"10.1177/17085381241289825","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze the treatment methods and efficacy of inferior vena cava filter thrombosis (IVCFT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In this retrospective study, the clinical data for 47 patients with IVCFT who underwent sequential treatment at the Department of Vascular Surgery, Tianjin Medical University Second Hospital, from January 2020 to January 2023 were analyzed. Patients were divided into three groups according to the treatment method: anticoagulant therapy (AC group), anticoagulation plus catheter-directed thrombolysis (CDT group), and anticoagulation plus AngioJet thrombectomy plus catheter-directed thrombolysis (PCDT group). The evaluation criteria for efficacy mainly included preoperative and postoperative clinical symptoms (Villalta score), thrombus diameter, thrombus clearance rate, filter retrieval rate, filter retention time, and urokinase dosage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 47 patients, of whom 31 were males (65.9%) and 16 females (34.1%), with a mean age of 72.05 ± 8.32 years. An Aegisy filter was used in seven patients, whereas an Illicium filter was used in forty patients. There were a total of nineteen patients in the anticoagulation-only group, with complete dissolution of the intraluminal thrombus in five patients, a residual thrombus with a maximum diameter ≤1 cm in three patients, and a residual thrombus with a maximum diameter &gt;1 cm in eleven patients. The Villalta score was 7.16 ± 0.6 before treatment and decreased to 3.79 ± 0.59 after treatment. The thrombus diameter decreased from an average of 1.46 ± 0.2 cm before treatment to an average of 0.85 ± 0.14 cm after treatment. The retrieval rate for the filters was 42.11% (8/19), with an average dwell time of 27.4 ± 1.3 days for the filters. The CDT group consisted of 17 patients. Among whom we observed, complete dissolution of the intraluminal thrombus was observed in six patients, residual thrombus with a maximum diameter ≤1 cm in nine patients, and residual thrombus with a maximum diameter &gt;1 cm in two patients. The Villalta score decreased from 7.53 ± 0.83 before treatment to 2.06 ± 0.39 after treatment. The thrombus diameter also decreased from 1.46 ± 0.16 cm before treatment to 0.35 ± 0.11 cm after treatment. The retrieval rate of the filters was 88.24% (15/17), and the average filter indwelling time was 19.25 ± 4.5 days. The PCDT group consisted of 11 patients. We observed complete dissolution of the intraluminal thrombus in four patients, residual thrombus with a maximum diameter ≤1 cm in six patients, and residual thrombus with a maximum diameter &gt;1 cm in one patient. The Villalta score decreased from 7.45 ± 0.76 before treatment to 2.09 ± 0.55 after treatment. The thrombus diameter decreased from 1.50 ± 0.21 cm before treatment to 0.33 ± 0.35 cm after treatment, and the rate of filter retrieval was 90.91% (10/11).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The three treatments of anticoagulation therapy, CD","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241289825"},"PeriodicalIF":1.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475961","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":"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":" ","pages":"17085381241289815"},"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":" ","pages":"17085381241289821"},"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}