EJVES Vascular Forum最新文献

{"title":"Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience","authors":"Yutaka Iba,&nbsp;Tomohiro Nakajima,&nbsp;Junji Nakazawa,&nbsp;Tsuyoshi Shibata,&nbsp;Shuhei Miura,&nbsp;Nobuyoshi Kawaharada","doi":"10.1016/j.ejvsvf.2024.12.001","DOIUrl":"10.1016/j.ejvsvf.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated.</div></div><div><h3>Methods</h3><div>This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: <em>n</em> = 4, type II: <em>n</em> = 1, type V: <em>n</em> = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%).</div></div><div><h3>Results</h3><div>Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%).</div></div><div><h3>Conclusion</h3><div>When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 32-40"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When and How to Perform Open Aortic Repair After Thoracic Endovascular Repair Complications?","authors":"Paulo Eduardo Ocke Reis ,&nbsp;Arindam Chaudhuri","doi":"10.1016/j.ejvsvf.2025.01.004","DOIUrl":"10.1016/j.ejvsvf.2025.01.004","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 30-31"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Characterisation of Peripheral Artery Disease: A Scoping Review on Current Classifications and New Insights Brought by Artificial Intelligence","authors":"Fabien Lareyre ,&nbsp;Lisa Guzzi ,&nbsp;Bahaa Nasr ,&nbsp;Ahmed Alouane ,&nbsp;Sébastien Goffart ,&nbsp;Andréa Chierici ,&nbsp;Hervé Delingette ,&nbsp;Juliette Raffort","doi":"10.1016/j.ejvsvf.2025.06.003","DOIUrl":"10.1016/j.ejvsvf.2025.06.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Several scan and imaging classifications have been described for the management of patients with peripheral artery disease (PAD). In parallel, artificial intelligence (AI) has brought new insights in vascular imaging analysis. This scoping review aimed to summarise imaging classification for PAD and to discuss how AI could be used to enhance these systems.</div></div><div><h3>Methods</h3><div>Medline was searched for relevant studies that addressed imaging classification and use of AI in PAD vascular imaging. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) protocol was followed.</div></div><div><h3>Results</h3><div>Thirty four articles were included. This paper provides an overview and discusses the advantages and limits of current imaging classifications used to characterise atherosclerotic lesions as well as calcifications in patients with PAD. AI offers new opportunities to enhance automatic detection and classification of PAD lesions, with potentially new techniques that could be used to assess vascular calcification and identify radiomic patterns.</div></div><div><h3>Conclusion</h3><div>AI has brought new opportunities to improve imaging software to facilitate robust and reproducible analysis of lower limb arterial lesions. In the future, such applications may contribute to improved clinical workflow and help decision making.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 87-95"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Relining with Custom Made Double Branch Aortic Arch Graft to treat a type Ia Endoleak after Zone 2 Branched TEVAR","authors":"Simona Sica ,&nbsp;Jonathan Sobocinski","doi":"10.1016/j.ejvsvf.2025.04.004","DOIUrl":"10.1016/j.ejvsvf.2025.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>Thoracic endovascular aortic repair (TEVAR) including a branch or fenestration offers a less invasive alternative to open surgery in the treatment of aortic arch pathologies. Nevertheless, the occurrence of a proximal type I endoleak (EL) in this specific setting may be particularly challenging to fix. This study presents the case of a type Ia endoleak after a zone 2 single branched TEVAR that was successfully treated with a proximal endovascular relining using a custom made double branch aortic arch graft.</div></div><div><h3>Case</h3><div>A 74 year old male presented with a 70 mm thoracic aortic aneurysm and a type Ia EL 7 years after a zone 2 TEVAR including a retrograde left subclavian artery branch. After multidisciplinary discussion, the patient underwent a hybrid repair with left carotid subclavian bypass and a custom made double branch aortic arch graft to extend proximal sealing into zone 0. The device that was used featured two antegrade inner branches for the brachiocephalic trunk and left common carotid artery. Post-operatively, the patient recovered well without neurological deficit. Follow-up imaging at three months confirmed patency of the supra-aortic trunks and favourable aortic remodelling without any residual endoleak.</div></div><div><h3>Conclusion</h3><div>This case suggests that proximal endovascular relining in zone 0 with a custom made double branch aortic arch for treating type Ia endoleak following left subclavian artery branch endograft is feasible and effective in experienced aortic centres.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 20-23"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia","authors":"Takuya Hashimoto ,&nbsp;Yoshitaka Kumakura ,&nbsp;Kenichi Ichikawa ,&nbsp;Satoshi Yamamoto ,&nbsp;Takashi Endo ,&nbsp;Masaya Sano ,&nbsp;Osamu Sato ,&nbsp;Juno Deguchi","doi":"10.1016/j.ejvsvf.2024.11.002","DOIUrl":"10.1016/j.ejvsvf.2024.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>Microcirculation focused evaluations may provide physiological insights that complement those of the established clinical criteria for patients with chronic limb threatening ischaemia (CLTI), since complex treatments are needed in this high risk population. However, current methods for quantitatively assessing foot microcirculation are limited. Thus, in this study, the aim was to demonstrate a proof of concept non-invasive method with novel parameters for assessing foot microcirculation.</div></div><div><h3>Methods</h3><div>This was a single centre prospective cohort pilot study. The lower limbs of 13 patients diagnosed with CLTI were evaluated by radionuclide (RN) angiography with ^99mTc-tetrofosmin two weeks after revascularisation or non-revascularisation procedures. Novel parameters (pedal transit time and peak pedal count) were derived by processing the time–activity curves of the detected tracers in each region of interest in the limbs. The Mann–Whitney <em>U</em> test was used for the analysis of associations between these two parameters and limb fate at one year, and Pearson and Spearman tests were used to analyse associations with transcutaneous partial oxygen pressure (tcPO₂), a conventional perfusion test result.</div></div><div><h3>Results</h3><div>The mean pedal transit time of the affected limbs in the non-healing group was longer than that in the healing group (19.1 ± 18.6 <em>vs</em>. 2.9 ± 2.1 seconds, <em>p</em> = .001). The mean peak pedal count of nucleotides in the non-healing group was lower than that in the healing group (24.4 ± 19.0 <em>vs</em>. 72.0 ± 36.1 counts/sec/GBq, <em>p</em> = .008). The pedal transit time and peak pedal count showed little to no correlation with the conventional tcPO₂ at the midfoot (<em>r</em> = 0.26 for pedal transit time; <em>r</em> = −0.11 for peak pedal count).</div></div><div><h3>Conclusion</h3><div>Two novel microcirculation parameters derived from RN angiography were associated with one year limb outcomes in patients with CLTI. Non-invasive radiotracer imaging derived parameters may provide an additional dimension to indices of pathophysiological microcirculation in CLTI.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 11-19"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143105331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undifferentiated Intimal Sarcoma of the Visceral Aorta With Recurrent Renovisceral Ischaemia Misdiagnosed as Takayasu's Arteritis","authors":"Martin Wenkel ,&nbsp;Kirsten de Groot ,&nbsp;Marius Fried ,&nbsp;Achim Neufang","doi":"10.1016/j.ejvsvf.2025.01.002","DOIUrl":"10.1016/j.ejvsvf.2025.01.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Malignant tumours of the aorta are a rare disease and often misdiagnosed as they masquerade as wall adjacent thrombus or inflammatory disease. Due to the often delayed diagnosis and the rapidly progressing illness, the outcome is very poor.</div></div><div><h3>Report</h3><div>A 50 year old female patient who had received coeliac and mesenteric artery stenting followed by an aortomesenteric bypass after stent occlusion two years earlier was treated. After an episode of hypertensive crisis caused by high grade stenosis of the renal arteries and review of previous tissue biopsies the diagnosis of Takayasu's arteritis was established, but the results were inconclusive. When presenting with a penetrating aneurysm of the renovisceral aorta, a complete reconstruction was performed of the renovisceral aorta due to impending rupture. Pre-operative imaging incidentally showed a sarcoma of the femur which was interpreted as an unrelated entity at the time. Finally, two years after the onset of the first symptoms, the diagnosis of an undifferentiated intimal sarcoma was established after extensive histological workup. However, the patient's condition deteriorated too quickly for her to recover as she had already developed multiple distant metastases and she died within three months of surgery.</div></div><div><h3>Discussion</h3><div>Due to its extreme rarity, this disease is not widely recognised, even among specialists. Accordingly, the patient was initially misdiagnosed and a malignant process was not considered. An accurate diagnosis at the time of the first open surgery might have presented the opportunity for radical resection of the affected aorta. Unfortunately, there are no non-invasive tools available to diagnose intimal sarcoma and, given the rapid progression of the disease, the prognosis remains poor, with a survival of only a few months.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 21-24"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-Thinking Antithrombotic Strategies in Non-Cardiac Arterial Procedures: Time for Standardisation?","authors":"Maria Katsarou ,&nbsp;Giuseppe Baldino","doi":"10.1016/j.ejvsvf.2025.03.003","DOIUrl":"10.1016/j.ejvsvf.2025.03.003","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 1-2"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Scanning Electron Microscopy Approach to Evaluate Paclitaxel Deposition From Drug Coated Balloons in a Human Cadaveric Peripheral Artery Disease Model","authors":"Judit Csore ,&nbsp;Alexander B. Crichton ,&nbsp;Jianhua Gu ,&nbsp;Bright Benfor ,&nbsp;Stuart Corr ,&nbsp;Kelvin Boateng ,&nbsp;Trisha L. Roy","doi":"10.1016/j.ejvsvf.2025.06.004","DOIUrl":"10.1016/j.ejvsvf.2025.06.004","url":null,"abstract":"<div><h3>Objective</h3><div>Drug coated balloons (DCBs) are used to treat peripheral artery disease (PAD) but concerns about their efficacy and safety persist. Current evaluation methods, relying on benchtop studies and animal models, do not replicate the complexity of human PAD lesions. This study aimed to develop a novel methodology to assess paclitaxel delivery from DCBs to human peripheral arteries with complex plaque morphologies using scanning electron microscopy (SEM) with the purpose of examining how plaque morphology and vessel preparation affect drug transfer in human cadaveric legs.</div></div><div><h3>Methods</h3><div>An amputated leg model from patients with PAD and standardised vessel preparation, imaging, and quantification methods was used. Arteries were treated with plain balloon angioplasty, cutting balloon angioplasty, or no preparation before DCB treatment. Vessels were imaged with high vacuum SEM, and drug coverage was quantified with ImageJ. Lesions were classified as nodular or smooth based on magnetic resonance imaging. Drug distribution was analysed at 300×300 μm field of view (FOV), categorised as minimal, moderate, good, or excellent.</div></div><div><h3>Results</h3><div>SEM was effective at imaging paclitaxel crystals transferred to the vessel wall. Plaque morphology affected the amount of drug transferred with smooth plaques exhibiting greater drug coverage than nodular plaques. In nodular plaques, drug was concentrated on the protruding portions of the plaque and not in the recesses, while smooth plaques showed more uniform distribution. Excellent coverage was seen in 38.31% of FOVs of smooth plaques <em>vs.</em> 10.58% of nodular plaques. Drug transfer was more consistent in smooth vessels, regardless of vessel preparation method. Cutting balloons enhanced drug delivery when grooves were formed.</div></div><div><h3>Conclusion</h3><div>This SEM based method effectively evaluated drug transfer in human PAD lesions, revealing greater drug delivery in smooth lesions and the impact of vessel preparation. This novel analytic model offers a platform for optimising DCB strategies to improve PAD patient outcomes.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 105-112"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound Guided Needle Penetration Technique for Recanalisation of Short Segment Chronic Femoral Vein Occlusion","authors":"Tamás Büki,&nbsp;Vasileios Leivaditis,&nbsp;Manfred Dahm","doi":"10.1016/j.ejvsvf.2025.02.004","DOIUrl":"10.1016/j.ejvsvf.2025.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>This case report presents an ultrasound guided needle penetration technique as a novel method for the recanalisation of short segment chronic femoral vein occlusion in a patient with a history of intravenous drug use.</div></div><div><h3>Case report</h3><div>A 41 year old male presented with a painful calf ulcer. Initial ultrasound imaging identified a chronic short segment occlusion in the proximal femoral vein, with extensive scarring from repeated intravenous drug injections. Traditional endovascular approaches were unsuccessful due to dense tissue scarring. The ultrasound guided needle penetration technique was employed to perforate the occlusion, achieving successful wire passage and subsequent stent placement. The patient experienced significant symptomatic relief after the procedure.</div></div><div><h3>Conclusion</h3><div>This case highlights the feasibility and benefits of ultrasound guided needle penetration as an alternative recanalisation approach in severe scarring peripheral chronic venous occlusion.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 61-64"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Intimal Invagination and Septectomy Following Electrosurgical Septotomy in a Patient With a Type B Dissection","authors":"Cecilie Markvard Møller,&nbsp;Steen Fjord Pedersen,&nbsp;Jacob Budtz-Lilly","doi":"10.1016/j.ejvsvf.2025.02.003","DOIUrl":"10.1016/j.ejvsvf.2025.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic endovascular aortic repair (T-EVAR) is the standard treatment in patients with a type B aortic dissection and appropriate indications for repair. The procedure requires anatomical, clinical, and technical scrutiny, as well as consideration for potential further repair. Supplementary procedures are not uncommon. Septotomy has received renewed interest as an adjunctive procedure, in the form of electrosurgical techniques, with the objective of improving true lumen landing zones and better access to important target branch vessels. Emerging reports suggest favourable clinical outcomes, although there are associated thromboembolic risks that clinicians should recognise.</div></div><div><h3>Case report</h3><div>This case report describes an important complication of electrosurgical septotomy causing aortic intimal invagination in a patient with a type B aortic dissection.</div></div><div><h3>Conclusion</h3><div>Electrosurgical septotomy is an effective method to gain improved landing zones for TEVAR endograft placement, but caution is warranted in the timing of this procedure.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 57-60"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}