Vascular最新文献

{"title":"Extra-anatomic bypass procedures for severe aortoiliac occlusive disease-A cohort study.","authors":"George Galyfos, Georgios Charalampopoulos, Alexandros Chamzin, Alexandra Triantafillou, Victoria Michalopoulou, Nikolaos Intzes, Despina Kimpizi, Konstantinos Zarmakoupis, Frangiska Sigala, Konstantinos Filis","doi":"10.1177/17085381241236558","DOIUrl":"10.1177/17085381241236558","url":null,"abstract":"<p><strong>Objectives: </strong>Extra-anatomic bypass (ExAB) grafting has been questioned due its inferior durability compared to anatomic bypass for aortoiliac occlusive disease (AIOD). This study aims to present early and late outcomes of patients treated with ExAB as well as to evaluate potential prognostic factors.</p><p><strong>Methods: </strong>This is a retrospective cohort study presenting a series of patients treated with ExAB for AIOD. All patients were treated between 2005 and 2022 within the Vascular Surgery Unit of a University Surgery Clinic. Both early (30-day) and late outcomes were evaluated. Univariate and multivariate analyses were conducted for potential predictors. Kaplan-Meier curve was produced for long-term patency.</p><p><strong>Results: </strong>A total of 41 patients were treated (85.3% males; mean age: 76.3 ± 4.2 years). Indication for treatment included severe claudication or critical limb ischemia (Rutherford stages III-VI). The following procedures were recorded: Femorofemoral bypass (FFB; <i>n</i> = 21) and axillofemoral bypass (AxFB; <i>n</i> = 20). All procedures were conducted using synthetic grafts with external rings. Early outcomes included no death, no myocardial infarction, no major bleeding, no graft infection, and no major amputation. Regarding late outcomes, 14.6% patients were lost after the first month. For the rest of patients (<i>n</i> = 35), five-year primary patency was 88.6%, primary-assisted patency was 94.3%, and secondary patency was also 94.3%. Limb salvage was 100% within follow-up. Endarterectomy at the distal anastomosis was the only independent predictor associated with worse patency in the long-term (OR = 5.356; 95% CI (1.012-185.562); <i>p</i> = .041).</p><p><strong>Conclusions: </strong>FFB and AxFB is a safe and durable strategy for treating patients with severe AIOD where no other option is feasible. Regarding predictors, only endarterectomy at the distal anastomosis site was associated with an increased risk for graft failure.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"87-95"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973728","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":"Explant of an infected, endo-trashed IVC filter in an immunosuppressed patient with chronically occluded iliocaval stents.","authors":"Alice Alexander, Andrew H Smith, Matthew Krantz, Robert Simon, Francis J Caputo, Jon G Quatromoni","doi":"10.1177/17085381241238832","DOIUrl":"10.1177/17085381241238832","url":null,"abstract":"<p><strong>Background: </strong>In the absence of a contiguous bowel perforation or intraabdominal source, infection of a retained vena cava filter in an occluded IVC has never been described.</p><p><strong>Objective: </strong>To describe a case of an infected IVC filter in a chronically occluded iliocaval segment.</p><p><strong>Methods: </strong>Here we present a case of an immunosuppressed 35-year-old female with chronically occluded iliocaval stents and an extensive staphylococcus hominis infection of a previously endo-trashed Bard Eclipse® filter. Particular attention is paid to supportive imaging in establishing the diagnosis and technical aspects of successful device explant and retroperitoneal debridement.</p><p><strong>Results: </strong>At 6 months postoperatively, the patient was doing well without evidence of recurrent infection. Her lower extremity edema was controlled with compression alone.</p><p><strong>Conclusions: </strong>The main objective of this operation was source control with debridement of the infection and removal of the filter and as much of the iliac vein as safely possible. Superinfection of a previously placed iliocaval stents and inferior vena cava filter remains a concern in patients with retroperitoneal infection and chronic iliocaval occlusion. Operative explant and debridement can be safely performed in patients with favorable cardiopulmonary risk.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"182-185"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120799","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-pulsed 1064nm Nd:YAG laser in the treatment of leg veins: Systematic review.","authors":"Leonor Baldaia, Marina Dias-Neto, João Almeida Pinto","doi":"10.1177/17085381241236587","DOIUrl":"10.1177/17085381241236587","url":null,"abstract":"<p><strong>Objective: </strong>Long-pulsed 1064 nm Nd:YAG laser can damage vessels with higher diameters and penetrate to a deeper level than other laser therapies. We aim to analyze outcomes of the treatment of leg veins with long-pulsed 1064 nm Nd:YAG laser regarding intervention protocol, technical success, clinical success, and side effects.</p><p><strong>Methods: </strong>A research of the published literature was conducted, using PubMed and Embase databases, in April 2022. The key words used were telangiectasia, reticular veins, neodymium YAG laser, clearance, satisfaction, and treatment. PRISMA guidelines were followed.</p><p><strong>Results: </strong>We included twenty-six articles, twenty-three prospective and three retrospective studies, with a total of 1991 patients. The articles were organized in different sections according to the control group. The four outcomes were analyzed in each section. These studies showed that the long-pulsed 1064 nm Nd:YAG laser is a safe and very good option for the treatment of leg veins measuring up to 3 mm in diameter. Studies comparing long-pulsed 1064 nm Nd:YAG laser therapy and sclerotherapy showed similar clearance rates with no significant differences. However, sclerotherapy seemed to be less painful and to have faster clinical improvements. In two articles, Nd:YAG laser had better outcomes in the treatment of smaller vessels with less than 1 mm in diameter, than sclerotherapy alone. Treatment with polidocanol microfoam and Nd:YAG laser had better clearance rates than Nd:YAG laser alone in three studies. In the comparison of 1064 nm Nd:YAG laser therapy with other lasers and light sources, the studies had contradictory results.</p><p><strong>Conclusion: </strong>Long-pulsed 1064 nm Nd:YAG laser is a valid therapeutic option for leg telangiectasia and reticular veins with great aesthetic outcomes and minor side effects. Nd:YAG laser therapy could be combined with sclerotherapy or other laser therapies or IPL in order to achieve better results. Serious side effects are rare, but the procedure is almost always accompanied by moderate tolerable pain.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"151-166"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983883","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":"Plethysmography: A game changer for chronic venous insufficiency diagnosis, treatment, and follow-up.","authors":"Hakan Guven","doi":"10.1177/17085381241240870","DOIUrl":"10.1177/17085381241240870","url":null,"abstract":"<p><strong>Objective: </strong>Chronic Venous Insufficiency (CVI) presents a various clinical symptoms and treatment options. Although it is generally known which treatment option is more appropriate in which situations in CVI, it is even more difficult to find the right option in some uncertain situations. In this study, we aimed to evaluate the potential contribution of Digital Photoplethysmography (D-PPG) in the diagnosis of CVI and especially in the selection of treatment options.</p><p><strong>Patients and method: </strong>This retrospective study was conducted at Bursa Heart and Arrhythmia Hospital, involving 721 consecutive patients diagnosed with CVI and with Endovenous Laser Ablation (EVLA) indication. The patients were divided into 2 groups according to the extent of the failure in Doppler USG. In Group 1, the insufficiency ended above the knee, and in Group 2, the insufficiency progressed to below the knee. Patients were evaluated based on anamnesis, physical examination, Doppler USG, and D-PPG. Clinical classification, Venous Clinic Severity Score (VCSS), Quality of Life (QoL) assessment, venous pump capacity (VPC), and venous refill time (VRT) were measured.</p><p><strong>Results: </strong>The study included 263 male and 458 female patients with a mean age of 52.37 ± 12.26 years. Significant differences were observed between Group 1 (above knee reflux) and Group 2 (below knee reflux) patients in terms of VCSS, QoL, VPC, and VRT values. The mean values of VCSS, patient complaints, VPC, and VRT were higher in Group 2 patients. Similar findings were observed within the CEAP 2 subgroup.</p><p><strong>Conclusion: </strong>D-PPG shows potential as a valuable tool in the diagnosis and treatment of CVI. By providing information about venous hemodynamics and volume changes, it can assist in optimizing treatment decisions, including saphenous vein preservation. Combining D-PPG with Doppler USG may improve the comprehensive assessment of CVI and change the treatment option, especially for CEAP 2 patients. More research is needed to confirm these findings and explore wider applications of plethysmographic methods in the management of CVI.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"192-199"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176736","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 knowledge of ChatGPT and Google Gemini in answering peripheral artery disease-related questions.","authors":"Hakkı Kursat Cetin, Tolga Demir","doi":"10.1177/17085381251315999","DOIUrl":"https://doi.org/10.1177/17085381251315999","url":null,"abstract":"<p><strong>Introduction: </strong>To assess and compare the knowledge of ChatGPT and Google Gemini in answering public-based and scientific questions about peripheral artery disease (PAD).</p><p><strong>Methods: </strong>Frequently asked questions (FAQs) about PAD were generated by evaluating posts on social media, and the latest edition of the European Society of Cardiology (ESC) guideline was evaluated and recommendations about PAD were translated into questions. All questions were prepared in English and were asked to ChatGPT 4 and Google Gemini (formerly Google Bard) applications. The specialists assigned a Global Quality Score (GQS) for each response.</p><p><strong>Results: </strong>Finally, 72 FAQs and 63 ESC guideline-based questions were identified. In total, 51 (70.8%) answers by ChatGPT for FAQs were categorized as GQS 5. Moreover, 44 (69.8%) ChatGPT answers to ESC guideline-based questions about PAD scored GQS 5. A total of 40 (55.6%) answers by Google Gemini for FAQs related with PAD obtained GQS 5. In addition, 50.8% (32 of 63) Google Gemini answers to ESC guideline-based questions were classified as GQS 5. Comparison of ChatGPT and Google Gemini with regards to GQS score revealed that both for FAQs about PAD, and ESC guideline-based scientific questions about PAD, ChatGPT gave more accurate and satisfactory answers (<i>p</i> = 0.031 and <i>p</i> = 0.026). In contrast, response time was significantly shorter for Google Gemini for both FAQs and scientific questions about PAD (<i>p</i> = 0.008 and <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Our findings revealed that both ChatGPT and Google Gemini had limited capacity to answer FAQs and scientific questions related with PDA, but accuracy and satisfactory rate of answers for both FAQs and scientific questions about PAD were significantly higher in favor of ChatGPT.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251315999"},"PeriodicalIF":1.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012509","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":"Surgical technique and outcomes associated with the use of femoral vein in venous reconstruction for superior vena cava syndrome.","authors":"Nathan J Reinert, Gesnyr Ocean, Ahmed A Sorour, Francis J Caputo, Levester J Kirksey, Jon G Quatromoni, Ravi N Ambani, Courtney R Hanak, Ali Khalifeh, Sean P Lyden","doi":"10.1177/17085381251313983","DOIUrl":"https://doi.org/10.1177/17085381251313983","url":null,"abstract":"<p><strong>Objective: </strong>Superior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction.</p><p><strong>Methods: </strong>This was a single-center, retrospective study that included all patients who underwent SVC reconstruction using femoral vein from January 2000 to December 2023. Follow-up period analysis included reconstruction patency, surgical reinterventions, patient's symptoms, and complications.</p><p><strong>Results: </strong>Ten patients underwent central venous reconstruction or bypass using the femoral vein, with an average age of 51.88 years ± 10.20 years. SVC syndrome was primarily caused by benign etiologies including pacemakers and indwelling central venous catheters. Common presenting symptoms included head or neck fullness and upper extremity edema. The median follow-up duration was 21 months. Primary patency at 1 year was 79%.</p><p><strong>Conclusion: </strong>Femoral vein reconstruction presents a promising solution for managing SVC obstruction, offering effective symptom relief and acceptable venous patency rates. Further research including prospective trials and comparative studies is crucial to refining surgical techniques and understanding long-term efficacy in addressing this complex clinical issue.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251313983"},"PeriodicalIF":1.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984819","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 laser fenestration of a frozen elephant trunk stent graft for treatment of chronic cerebral malperfusion.","authors":"Richard Shi, Sanford Manning Zeigler, Mathew David Wooster","doi":"10.1177/17085381251313581","DOIUrl":"https://doi.org/10.1177/17085381251313581","url":null,"abstract":"<p><strong>Objectives: </strong>Mal-deployment of the thoracic endovascular aortic repair (TEVAR) stent graft during a frozen elephant trunk (FET) procedure for an acute type A aortic dissection (ATAAD) leads to devastating complications. We report a hemiarch replacement with TEVAR stent graft covering the aortic arch vessels salvaged through an endovascular approach.</p><p><strong>Methods: </strong>A 69-year-old man with ATAAD in 2018, status post-hemiarch repair with TEVAR, presented in 2023 with progressive dizziness/syncope and lower extremity hypertension with inability to tolerate anti-hypertensives. A CT scan revealed TEVAR stent graft coverage of the brachiocephalic, left common carotid (LCA), and left subclavian artery (LSA), with retrograde flow into the arch vessels through a false lumen fed by a dissection fenestration at the aortic bifurcation. Given an elevated peri-operative death and stroke risk with an open arch revision, we performed an in situ anterograde laser fenestration of his FET with LCA and LSA stenting via the Culotte technique.</p><p><strong>Results: </strong>On 1 year follow-up, the patient's dizziness has resolved, and he has maintained normotension via anti-hypertensives.</p><p><strong>Conclusion: </strong>Laser fenestration and the Culotte technique can be used to salvage a TEVAR causing coverage of the arch vessels, showing that endovascular techniques can be a safe alternative for rescuing mal-positioned FETs.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251313581"},"PeriodicalIF":1.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955661","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":"Outcomes of patients with acute complicated type B aortic dissections repaired with the Zenith dissection endovascular system compared to aortic stent graft.","authors":"Nicola Habash, Avinash Saraiya, Michael Nooromid, Dawn Salvatore, Paul DiMuzio, Babak Abai","doi":"10.1177/17085381251313600","DOIUrl":"https://doi.org/10.1177/17085381251313600","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to evaluate the safety and effectiveness of the Zenith Dissection Endovascular System (ZDES; Zenith TX2 Dissection Endovascular Graft with Pro-Form and Zenith Dissection Endovascular Stent), which uses a proximal stent graft along with a distal bare metal stent compared to traditional stent grafts in the repair of acute, complicated Type B Aortic Dissection (AcTBAD).</p><p><strong>Methods: </strong>This retrospective study reviews the medical charts of 32 patients with AcTBAD repaired at a single urban academic medical center. 16 of these AcTBAD cases were repaired with the ZDES (87.5% male; mean age, 63.1 years), and 16 were repaired with stent grafts (62.5% male; mean age, 60.6 years). Outcomes include 30-day morbidity, false lumen thrombosis and aneurysmal degeneration at 6 months and 1 year, thirty-day and three-year mortality, and freedom from secondary surgical intervention.</p><p><strong>Results: </strong>Twelve total postoperative adverse events occurred in the ZDES group compared to 37 in the stent graft group (<i>p = .046</i>). The notable adverse events included renal insufficiency (<i>p = .04</i>) and refractory pain (<i>p = .002</i>). At the 6-month follow-up, complete or partial false lumen thrombosis was noted in 100% of patients (16/16) in the ZDES group and 56.3% of patients (9/16) in the stent graft group (<i>p < .01</i>). At the 12-month follow-up, complete or partial thrombosis of the false lumen was noted in 1 additional patient in the stent graft group for a total of 62.6% of patients (10/16; <i>p = .018</i>). Growth (>5 mm) of the maximum transaortic diameter at 12 months was noted in 33.3% of patients (5/15) in the ZDES group and 54% of patients (7/13) in the stent graft group (<i>p = .45</i>). Thirty-day mortality occurred in one patient in the ZDES group and no patients in the stent graft group (<i>p = 1.0</i>). Three-year mortality occurred in four patients in the stent graft group and no patients in the ZDES group (<i>p = .11</i>). Although more patients in the ZDES group underwent secondary intervention to address aortic growth, there were no differences between the two groups in freedom from any secondary intervention at 365 days post-procedure (<i>p = .13</i>).</p><p><strong>Conclusions: </strong>Patients treated with ZDES had fewer post-procedural adverse events. Although the use of the ZDES had favorable false lumen thrombosis at 6 and 12 months, the device was not associated with a statistically significant change in transaortic diameter. Our single institution study demonstrated that ZDES has favorable clinical outcomes, but further investigation is needed to better understand aortic remodeling in the distally stented regions. Additionally, further research is necessary to explore the incidence of endoleaks associated with ZDES to optimize long-term patient outcomes.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251313600"},"PeriodicalIF":1.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932490","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":"Transcaval embolisation of type-II endoleaks - The Australian experience.","authors":"Kevin Tian, Vimalin Samuel, David Sun, Dylan Morris, Yew Toh Wong, Ramesh Velu","doi":"10.1177/17085381241313251","DOIUrl":"https://doi.org/10.1177/17085381241313251","url":null,"abstract":"<p><strong>Objectives: </strong>Embolizing an abdominal aortic aneurysm sac through a transcaval approach is a novel approach to treat type-II endoleaks that occur following aortic endografting. This study reviews the outcomes of this treatment in one of the few centres in Australia that offers this procedure.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including patients who had received transcaval embolisation of type-II endoleak over a 9-year period. The primary outcome was clinical success, defined as the absence of endoleak on post-procedural ultrasonography at 6-weeks, provided the procedure was successfully completed. Other outcomes included clinical success at 1-year, aneurysm size, rupture and aneurysm-related mortality.</p><p><strong>Results: </strong>Twelve patients with type-II endoleak and AAA sac growth received transcaval embolisation. Technical success was achieved in 91.7% of cases, in which both Onyx 34 and coils were deployed into the sac. Clinical success, defined as an absence of endoleak on ultrasonography 6-weeks after a technically successful procedure, was achieved in 66.7% of patients, none of whom had evidence of endoleak at 1-year post-procedure. In patients whom clinical success was achieved, there was a decrease in sac size during follow-up, from 72.5 ± 13.1 at 6-weeks to 66.0 ± 12.1 at 1-year post-procedure. Aneurysm sac size continued to enlarge if clinical success was not observed, with an average sac size of 72.0 ± 14.1 at 6-weeks increasing to 76.9 ± 15.2 at 1-year. No patients suffered AAA rupture or AAA-related mortality during follow-up.</p><p><strong>Conclusions: </strong>This study reports a high technical and clinical success rate, with outcomes that could suggest that this procedure could induce sac regression.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241313251"},"PeriodicalIF":1.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932670","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":"Limb salvage prediction in peripheral artery disease patients using angiographic computer vision.","authors":"Yury Rusinovich, Vitalii Liashko, Volha Rusinovich, Alina Shastak, Leon Bruder, Safwan Omran, Andreas Greiner, Markus Doss, Daniela Branzan","doi":"10.1177/17085381241312467","DOIUrl":"https://doi.org/10.1177/17085381241312467","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) outcomes often rely on the expertise of individual vascular units, introducing potential subjectivity into disease staging. This retrospective, multicenter cohort study aimed to demonstrate the ability of artificial intelligence (AI) to provide disease staging based on inter-institutional expertise by predicting limb outcomes in post-interventional pedal angiograms of PAD patients, specifically in comparison to the inframalleolar modifier in the Global Limb Anatomic Staging System (IM GLASS).</p><p><strong>Methods: </strong>We used computer vision (CV) based on the MobileNetV2 model, implemented via TensorFlow.js library, for transfer learning and feature extraction from 518 pedal angiograms of PAD patients with known 3-month limb outcomes: 218 salvaged limbs, 140 minor amputations, and 160 major amputations.</p><p><strong>Results: </strong>After 43 epochs of training with a learning rate of 0.001 and a batch size of 16, the model achieved a validation accuracy of 95% and a test accuracy of 93% in differentiating salvaged limbs from amputations. In manual testing with 45 angiograms excluded from the training, validation, and test processes, the AI predicted mean limb salvage probabilities of 96% for actual salvaged limbs, 27% for minor amputations, and 17% for major amputations (<i>p</i>-value < .001). The correlation coefficient between the CV model-predicted outcome and the actual outcome for these 45 angiograms was 0.7, nearly five times higher than that between the IM GLASS pattern and the actual outcome (0.14).</p><p><strong>Conclusion: </strong>Computer vision can analyze angiograms and predict disease outcomes, demonstrating a significant correlation between predicted and actual limb salvage rates, outperforming IM GLASS segmentation by a vascular specialist. It has the potential to provide immediate and precise treatment results during vascular interventions, tailored to (inter)institutional expertise, and enhance individualized decision-making.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241312467"},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923396","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}