Vascular最新文献

{"title":"Epidemiology of the use of inferior vena cava filters in Brazil between 2008 and 2019.","authors":"Andressa Cristina Sposato Louzada, Dafne Braga Diamante Leiderman, Marcelo Fiorelli Alexandrino da Silva, Maria Fernanda Cassino Portugal, João Carlos de Campos Guerra, Marcelo Passos Teivelis, Nelson Wolosker","doi":"10.1177/17085381231164923","DOIUrl":"10.1177/17085381231164923","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective was to study the totality of inferior vena cava filter placements and their temporal and geographic distribution in the Brazilian Public Health System, which insures more than 160 million Brazilians. The secondary objective was to analyze in-hospital mortality after filter placement and deaths due to pulmonary embolism.</p><p><strong>Methods: </strong>Public and open data on in-hospital mortality due to pulmonary embolism and on rates of inferior vena cava filters placement, its associated diagnosis, and in-hospital mortality in Brazilian public hospitals between January 2008 and December 2019 were extracted from Ministry of Health databases.</p><p><strong>Results: </strong>A total of 9108 inferior vena cava filters were placed, 98.18% of which was therapeutic. We observed a significant increase in the use of these devices over the years, from 508 inferior vena cava filters placed in 2008 to 965 in 2019. In-hospital mortality rate in patients who received inferior vena cava filters was 6.21%, stable over time, and 96.64% of causes of these causes were attributed to venous thromboembolism. The in-hospital mortality rate due to pulmonary embolism, regardless of the placement of vena cava filters, has increased significantly.</p><p><strong>Conclusion: </strong>We observed a low but increasing rate of inferior vena cava filter placements in Brazil between 2008 and 2019, most indications were therapeutic. Our findings were heterogeneous across Brazilian regions and contrasted to those observed in the USA, which is likely due to cultural and socioeconomic factors.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"1092-1098"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9500465","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":" ","pages":"17085381241289484"},"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":" ","pages":"17085381241289485"},"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":" ","pages":"17085381241269747"},"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":"2 1","pages":""},"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":"15 1","pages":"17085381241283096"},"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":"13 1","pages":"17085381241283519"},"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}

{"title":"Comparative outcomes between cryopreserved cadaveric saphenous vein and spliced autogenous vein for infrainguinal bypass","authors":"Christopher Montoya, Fang Yuan, Lea Tordjman, Akashara Challa, Christopher Chow, Naixin Kang, Tony Shao, Stefan Kenel-Pierre, Jorge Rey, Arash Bornak","doi":"10.1177/17085381241283123","DOIUrl":"https://doi.org/10.1177/17085381241283123","url":null,"abstract":"ObjectiveCryopreserved greater saphenous vein (CV) and spliced autogenous veins (SV) serve as alternative conduits for lower extremity revascularization when a single-segment autogenous saphenous vein is not available. This study compares the outcomes of infrainguinal bypasses using CV and two-segment SV as conduits.MethodsWe conducted a retrospective review of data on all lower extremity bypasses performed using CV or SV at our institution. Patients undergoing revascularization for atherosclerotic occlusive disease were included in the statistical analysis, while those with primary acute embolic and/or traumatic causes were excluded. Primary outcomes included limb loss. Secondary outcomes included primary, primary assisted, and secondary patency at one and 3 years.Results56 patients were included in the analysis, 25 had CV bypass and 31 had SV. The groups did not significantly differ in demographics and comorbidities except for age (mean age 68 CV vs 62 SV, p = .03), and prior coronary artery bypass graft (32% CV vs 6.5% SV, p = .01). There was no statistically significant difference between CV and SV at one- and three-years in limb salvage (54.4% CV vs 61.7% SV, p = .96 and 48.3% CV vs 50.2% SV, p = .94), and bypass abandonment (44.2% CV vs 61.7% SV, p = .83 and 44.2% CV vs 44% SV, p = .85). Despite lower one and 3-year primary patency for CV compared to SV (33.3% CV vs 54.9% SV, p = .29, and 27.7% CV vs 48% SV, p = .27), the difference was statistically not significant. CV and SV had also similar one and 3-year primary assisted (41.8% CV vs 57.8% SV, p = .72 and 41.8% CV vs 44.9% SV, p = .71), and secondary patency (43.9% CV vs 61.7% SV, p = .8 and 43.9% CV vs 44% SV, p = .88), with no statistically significant difference.ConclusionIn patients for whom single-segment autologous saphenous vein bypass is not an option, CV and SV show comparable limb salvage up to 3 years. SV may be a more durable option with higher patency, this was however not statistically significant in our cohort likely due to sample size.","PeriodicalId":23549,"journal":{"name":"Vascular","volume":"2022 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187433","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":"Female gender is independently associated with longer hospital stays following infra-inguinal bypass for peripheral arterial disease. A retrospective cohort study.","authors":"Daniel J Farndon, Sri Vulla, Philip C Bennett","doi":"10.1177/17085381241281315","DOIUrl":"https://doi.org/10.1177/17085381241281315","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The association between gender and length of hospital stay following infra-inguinal bypass (IIB) surgery is unclear. While previous studies have reported gender disparities in length of hospital stay (LoS), the results are conflicting and could be attributable to other confounding factors. We undertook this cohort study to determine if there are any gender differences in length of hospital stay following infra-inguinal bypass for PAD after adjusting for well-known confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 3-year single-centre retrospective case notes analysis of all people undergoing IIB between 2017 and 2019. Rutherford stage, graft conduit, urgency of bypass, level of bypass, procedure details, baseline demographics, length of stay (LoS) and co-morbidities were collected and univariable associations with length of hospital stay were reported. Factors associated with increased LoS on univariable analysis were entered into a multivariable model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;177 IIB were analysed with a median age of 70 [63-73] years, 124 (70.1%) were male and 89 (50.2%) had DM. A total of 78 (44.1%) were current smokers, and 100 (56.5%) underwent emergency procedures. The cohort included patients with Rutherford stage 3 (&lt;i&gt;n&lt;/i&gt; = 41 (23.2%)), stage 4 (&lt;i&gt;n&lt;/i&gt; = 48 (27.1%)), stage 5 (&lt;i&gt;n&lt;/i&gt; = 86 (48.6%)) and stage 6 (&lt;i&gt;n&lt;/i&gt; = 1 (0.6%)) disease. A total of 100 (56.5%) underwent emergency procedures. The conduits used were prosthetic (&lt;i&gt;n&lt;/i&gt; = 62 (35%)), vein (&lt;i&gt;n&lt;/i&gt; = 113 (63.8%)) and composite (&lt;i&gt;n&lt;/i&gt; = 2 (1.1%)), and the level of distal anastomosis was above knee (&lt;i&gt;n&lt;/i&gt; = 49 (27.7%)), below knee (&lt;i&gt;n&lt;/i&gt; = 66 (37.3%)) and distal (&lt;i&gt;n&lt;/i&gt; = 62 (35%). Baseline demographics did not differ by gender, and there were no differences in post-operative complications. The proportion of patients discharged to their usual place of residence without a package of care did not differ by gender (&lt;i&gt;p&lt;/i&gt; = .387). However, length of stay for female patients was significantly longer than for male patients (9 [6-21] vs 7 [5-14] days, &lt;i&gt;p&lt;/i&gt; = .021). Other factors associated with increased LoS on univariable analysis were emergency versus elective (&lt;i&gt;p&lt;/i&gt; &lt; .0001), Rutherford stage (&lt;i&gt;p&lt;/i&gt; &lt; .0001), bypass level (&lt;i&gt;p&lt;/i&gt; = .001), bypass conduit (&lt;i&gt;p&lt;/i&gt; = .001), post-operative complications (&lt;i&gt;p&lt;/i&gt; &lt; .0001) and discharge to rehab or home with package of care (&lt;i&gt;p&lt;/i&gt; &lt; .0001). Patients operated on by a female surgeon also had a longer hospital stay (14 [8-20] vs 7 [5-14], &lt;i&gt;p&lt;/i&gt; = .011) than those operated on by a male surgeon. After multivariate adjustment for bypass urgency, level and conduit, Rutherford stage, presence of post-operative complications and discharge destination, female gender (RR 1.59 95% CI: 1.09-2.3, &lt;i&gt;p&lt;/i&gt; = .017) was still associated with increased length of hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Even after adjustment for well-known factors associated with length of ","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241281315"},"PeriodicalIF":1.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133950","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":"Axillary compared to brachial access for endovascular procedures.","authors":"Mustafa A Altaha, Shawn Bailey, Sebastian Mafeld, Arash Jaberi, Kong Teng Tan","doi":"10.1177/17085381241279142","DOIUrl":"https://doi.org/10.1177/17085381241279142","url":null,"abstract":"<p><strong>Objectives: </strong>Limited knowledge exists regarding access site complication rates between trans-axillary and trans-brachial approaches with sheath sizes ≥6Fr. We retrospectively reviewed our institution experience with access site complications for percutaneous trans-axillary and trans-brachial arterial interventions using sheath sizes ranging from 6Fr to 10Fr.</p><p><strong>Methods: </strong>We examined 67 endovascular interventions performed over 18 months, restricted to sheath sizes of 6Fr to 10Fr. Procedures utilizing trans-brachial (41 cases) and trans-axillary (26 cases) approaches under sonographic guidance were included. Cases involving hemodialysis accesses and those requiring surgical cut-down were excluded. The primary outcome measure was the occurrence of major access site complications (SIR grade-II/III) within 30 days, with data collected on hemostasis method, sheath size, and complications. Statistical analysis involved ANCOVA and Fisher's exact tests, with significance set at <i>p</i> < .05.</p><p><strong>Results: </strong>Successful percutaneous arterial access was achieved in all cases using either approach (trans-axillary or trans-brachial). Closure devices were employed in all axillary punctures and in 71% of brachial punctures. Major access site complications occurred in 7 out of 41 cases (17%) in the trans-brachial group and in 4 out of 26 cases (15%) in the trans-axillary group. However, there was no statistically significant difference in complication rates between the two groups, regardless of access site or sheath size.</p><p><strong>Conclusion: </strong>Trans-axillary access serves as a safe and effective upper limb access method for percutaneous endovascular procedures requiring sheath size of 7Fr or larger when compared to trans-brachial approach.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381241279142"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112490","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}