EJVES Vascular Forum最新文献

{"title":"Bottom up Treatment for Vulvar and Lower Extremity Varicose Veins of Pelvic Origin: A Case Report","authors":"Aleksandra Jaworucka-Kaczorowska ,&nbsp;Marianne De Maeseneer","doi":"10.1016/j.ejvsvf.2024.12.004","DOIUrl":"10.1016/j.ejvsvf.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Extrapelvic varices of pelvic origin, such as vulvar varices, and lower extremity varicose veins (VVs) of pelvic origin are being diagnosed with increasing frequency. A proper management strategy, including history, physical examination, duplex ultrasound (DUS) of the lower extremities, DUS of pelvic escape points, selection of appropriate treatment, and post-treatment care, is essential for good patient outcomes and satisfaction.</div></div><div><h3>Case report</h3><div>A non-pregnant, 27 year old female presented with prominent vulvar varices in combination with right sided VVs on the anterior and medial thigh, calf, and buttock. She was successfully managed by bottom up treatment with ultrasound guided foam sclerotherapy. The bottom up technique involves treatment of VVs of pelvic origin by direct puncture of the pelvic escape points and associated VVs, without embolisation of the pelvic veins.</div></div><div><h3>Conclusion</h3><div>This case illustrates successful bottom up treatment in accordance with recent guidelines in a female patient with extensive VVs of pelvic origin.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 53-56"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610200","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":"A Case of Successful Explantation of an Infected Fenestrated Aortic Endograft Using a Composite Xeno/Biosynthetic In Situ Reconstruction","authors":"Tania Panettella ,&nbsp;Maani Hakimi ,&nbsp;Juan Antonio Celi de la Torre","doi":"10.1016/j.ejvsvf.2025.01.001","DOIUrl":"10.1016/j.ejvsvf.2025.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Graft infections after open or endovascular repair can be devastating, and their treatment is always challenging. For thoraco-abdominal and abdominal aortic aneurysms, fenestrated and branched endografts are used increasingly. Because of the involved materials and anatomy, infective complications can be even more complex.</div></div><div><h3>Report</h3><div>One year after double fenestrated endovascular endorepair for a type Ia endoleak after standard endovascular repair, a 77 year old patient developed clinical signs for sepsis at an external clinic. As his clinical situation deteriorated, he was then referred to the centre, where an infection focus search revealed a <em>Staphylococcus aureus</em> bacteraemia, and computed tomography (CT), and fludeoxyglucose positron emission tomography CT showed signs of endograft infection. Trestment by endograft explantation followed, and <em>in situ</em> reconstruction with a composite xeno/biosynthetic graft was performed. Through a median laparotomy, endograft explantation as well as <em>in situ</em> reconstruction were technically successful, and sepsis control was achieved under concomitant anti-infective therapy. After a 48 day hospital stay (22 days in the intensive care unit), the patient was discharged to a rehabilitation clinic. After three months of uneventful follow up, precision dual antibiotic therapy with ciprofloxacin and rifampicin was stopped. Four year follow up confirmed freedom from infection and a properly functioning aortic reconstruction.</div></div><div><h3>Discussion</h3><div>After fenestrated stent graft procedures, successful late conversion is challenging and is known to correlate with high morbidity and mortality. The present case confirms the feasibility of this approach, even in patients with sepsis, with good results.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 25-29"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422401","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":"“Bottom Up” Treatment for Vulvar and Lower Extremity Varicose Veins of Pelvic Origin: Keeping It Simple and Effective","authors":"Maria Katsarou","doi":"10.1016/j.ejvsvf.2025.02.001","DOIUrl":"10.1016/j.ejvsvf.2025.02.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Page 52"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610201","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":"Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke","authors":"Theodora van Elk ,&nbsp;Louise Maes ,&nbsp;Anne van der Meij ,&nbsp;Robin Lemmens ,&nbsp;Maarten Uyttenboogaart ,&nbsp;Gert J. de Borst ,&nbsp;Clark J. Zeebregts ,&nbsp;Paul J. Nederkoorn","doi":"10.1016/j.ejvsvf.2023.12.002","DOIUrl":"10.1016/j.ejvsvf.2023.12.002","url":null,"abstract":"<div><p>Fifteen to 20% of patients with an acute ischaemic stroke have a tandem lesion defined by the combination of an intracranial large vessel thrombo-embolic occlusion and a high grade stenosis or occlusion of the ipsilateral internal carotid artery. These patients tend to have worse outcomes than patients with isolated intracranial occlusions, with higher rates of disability and death. The introduction of endovascular thrombectomy to treat the intracranial lesion clearly improved the outcome compared with treatment with intravenous thrombolysis alone. However, the best treatment strategy for managing the extracranial carotid artery lesion in patients with tandem lesions remains unknown. Current guidelines recommend carotid endarterectomy for patients with transient ischaemic attack or non-disabling stroke and moderate or severe stenosis of the internal carotid artery, within two weeks of the initial event, to prevent major stroke recurrence and death. Alternatively, the symptomatic carotid artery could be treated by endovascular placement of a stent during endovascular thrombectomy (EVT). This would negate the need for a second procedure, immediately reduce the risk of stroke recurrence, increase patient satisfaction, and could be cost effective. However, the administration of dual antiplatelet therapy could potentially increase the risk of symptomatic intracranial haemorrhage in patients with acute ischaemic stroke. Randomised controlled trials evaluating the efficacy and safety of immediate carotid artery stenting during EVT in acute stroke patients with tandem lesions are currently ongoing and will impact the current guidelines regarding the treatment of patients with acute ischaemic stroke due to these tandem lesions.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 31-35"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X23000941/pdfft?md5=769eb62096929f360595d75df811e67a&pid=1-s2.0-S2666688X23000941-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139016765","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":"Validity of Ultrasound for the Diagnosis of Arterial Thoracic Outlet Syndrome","authors":"Emilia Stegemann ,&nbsp;Jana Larbig ,&nbsp;Berthold Stegemann ,&nbsp;Irene Portig ,&nbsp;Hans Prescher ,&nbsp;Thomas Bürger","doi":"10.1016/j.ejvsvf.2024.02.003","DOIUrl":"10.1016/j.ejvsvf.2024.02.003","url":null,"abstract":"<div><h3>Objective</h3><p>Thoracic outlet syndrome (TOS) is a rare disorder mostly seen in younger individuals. Although patient wellbeing is relevantly impaired, it often takes a long time before the diagnosis is made. Digital subtraction angiography (DSA) is routinely used despite its radiation exposure, which is a major concern in this young patient population. Moreover, DSA offers limited opportunities for functional assessment. By contrast, ultrasonography is widely accessible without causing radiation exposure and allows for flexible functional assessment. The main goal of the study was to investigate whether ultrasound (US) was a viable alternative to DSA in diagnosing arterial TOS (aTOS).</p></div><div><h3>Methods</h3><p>Patients, referred to a tertiary centre for evaluation of suspected TOS, were recruited into the study. DSA was routinely performed with the patient's arms both in the raised (abducted) and neutral (adducted) position. Two vascular surgeons and two radiologists assessed the resulting images for the presence of aTOS. Additionally, two examiners performed US according to a standardised protocol. The reference for presence of aTOS was the DSA based interdisciplinary vascular conference consensus. Inter-rater agreement and latent class analysis (LCA) were performed between assessors and diagnostic methods.</p></div><div><h3>Results</h3><p>Fifty one consecutive patients (two thirds female) aged 39.3 ± 13.0 years were included within 11 months. US agreement was excellent at 0.94 (0.841–0.980), DSA agreement for vascular surgeons was good at 0.779 (0.479–1.000), whereas it was moderate at 0.546 (0.046–1.000) for radiologists. Results suggest that DSA is untenable as the gold standard for aTOS diagnosis. In LCA, US was shown to be a reliable diagnostic tool for the detection of aTOS.</p></div><div><h3>Conclusion</h3><p>US examination is a valid test for the detection of haemodynamically relevant compression of arteries in the diagnostic work up of aTOS using a standardised protocol. The role of DSA as the gold standard should be reviewed and needs to be reconsidered.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 92-98"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000741/pdfft?md5=4a8589826fa1be077c2e2cf259161e9b&pid=1-s2.0-S2666688X24000741-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139823996","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":"EJVES Vascular Forum Moves Forward","authors":"Melina Vega de Ceniga,&nbsp;Arindam Chaudhuri","doi":"10.1016/j.ejvsvf.2024.02.001","DOIUrl":"10.1016/j.ejvsvf.2024.02.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 89-91"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000571/pdfft?md5=db1cf6102432c8502bf70576d7ea18e8&pid=1-s2.0-S2666688X24000571-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139880156","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":"Effectiveness of Endovascular Management of Chronic Pelvic Pain in Pelvic Congestion Syndrome Type I","authors":"Mohamed Hagag ,&nbsp;Mostafa soliman Abdelbary ,&nbsp;Mohamed Ismail ∗ ,&nbsp;Mohamed Emam fakhr","doi":"10.1016/j.ejvsvf.2024.01.063","DOIUrl":"https://doi.org/10.1016/j.ejvsvf.2024.01.063","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages S43-S44"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000662/pdfft?md5=39a3de0283df1fe6b0986182fe133120&pid=1-s2.0-S2666688X24000662-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051507","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":"Iatrogenic Aorta-Iliac laparoscopic Injuries","authors":"Asiyah Shafi ∗ ,&nbsp;Taohid Oshodi","doi":"10.1016/j.ejvsvf.2024.01.030","DOIUrl":"https://doi.org/10.1016/j.ejvsvf.2024.01.030","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages S21-S22"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000315/pdfft?md5=30879a44bb649bdf443d862eeeea647d&pid=1-s2.0-S2666688X24000315-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051603","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":"Arterial Blood Flow and Effects on Limb Tissue Perfusion During Endoshunting of the Common Iliac Artery in an Experimental Porcine Model","authors":"Johan Millinger ,&nbsp;Marcus Langenskiöld ,&nbsp;Andreas Nygren ,&nbsp;Klas Österberg ,&nbsp;Joakim Nordanstig","doi":"10.1016/j.ejvsvf.2024.01.053","DOIUrl":"10.1016/j.ejvsvf.2024.01.053","url":null,"abstract":"<div><h3>Objective</h3><p>Temporary arterial shunting is an established method to prevent tissue ischaemia. Although less well established, shunting might also be achieved through endovascular and hybrid techniques, known as endoshunting. Endoshunting offers advantages, for example, enabling minimally invasive access and avoiding complete occlusion of the donor artery. In an <em>ex vivo</em> bench test, volume flow in various interconnected endoshunt systems has been tested previously. This study aimed to investigate the capacity of the best performing endoshunt system <em>in vivo</em>.</p></div><div><h3>Methods</h3><p>Six anaesthetised pigs had their common iliac arteries (CIAs) explored, with the left CIA serving as the experimental and the right CIA as the control. Mean arterial pressure, regional blood flow, endoshunt flow, and regional oxygen extraction and lactate production were recorded. Distal muscle perfusion was monitored using near infrared spectroscopy (NIRS). Each experiment involved baseline registration, cross clamping of the left CIA, a 120 minute endoshunt session, and restoration of native flow.</p></div><div><h3>Results</h3><p>During cross clamping, NIRS values on the experimental side reached the lowest measurable value. Following endoshunt activation, there were no NIRS value differences between the experimental and control extremities whereas the average arterial flow decreased in both the experimental (270–140 mL/min, <em>p</em> = .028) and control extremities (245–190 mL/min, <em>p</em> = .25), with a greater drop on the endoshunted side (48% <em>vs.</em> 22%, respectively). Lactate levels temporarily increased by 42% in the endoshunted limb on endoshunt activation but were normalised within an hour. Oxygen extraction remained constant at 55% on the control side but increased to 70% on the endoshunted side (<em>p</em> = .068).</p></div><div><h3>Conclusion</h3><p>In this animal model, a flow optimised endoshunt system appeared to provide sufficient blood flow and restored stable tissue perfusion. Although arterial flow was slightly lower and oxygen extraction slightly higher on the endoshunted side, the endoshunt seemed to deliver adequate perfusion to prevent significant ischaemia.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 54-61"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000546/pdfft?md5=c0b8a6a14da3121115e5c222a598a45a&pid=1-s2.0-S2666688X24000546-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139634457","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":"A Two Stage Open and Interventional Therapeutic Approach for an Inferior Pancreaticoduodenal Artery Aneurysm With Coeliac Artery Occlusion","authors":"Polina Shabes ,&nbsp;Waseem Garabet ,&nbsp;Peter Minko ,&nbsp;Joscha Mulorz ,&nbsp;Julian-Dario Rembe ,&nbsp;Hubert Schelzig ,&nbsp;Markus U. Wagenhäuser","doi":"10.1016/j.ejvsvf.2024.06.005","DOIUrl":"10.1016/j.ejvsvf.2024.06.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Visceral artery aneurysms (VAAs) are rare but have a high mortality rate in cases of rupture, especially for pancreaticoduodenal artery aneurysms (PDAAs). A hybrid approach is presented for a challenging case with inferior PDAA (iPDAA) with concomitant coeliac artery (CA) occlusion and a variant arterial supply to the liver.</p></div><div><h3>Report</h3><p>A 61 year old patient complained of postprandial pain associated with elevated liver enzymes and impaired hepatic synthesis capacity. The left hepatic artery (LHA) originated from an occluded CA, whereas the right hepatic artery (RHA) originated directly from the superior mesenteric artery (SMA) proximal to the iPDAA. Due to the anatomical variant, an endovascular only approach via iPDAA embolisation could have posed a critical risk to the arterial supply of the liver. Therefore, the initial plan was to first secure liver perfusion via endovascular revascularisation of the CA, before conducting a coil embolisation of the iPDAA. However, endovascular CA revascularisation failed due to a complete and fixed occlusion. As an alternative therapeutic approach, open surgical aorto-visceral autologous bypass ensured arterial supply of the liver, which now enabled safe exclusion of the iPDAA via interventional coil embolisation. This two stage hybrid strategy resulted in iPDAA exclusion and was followed by symptom relief and normalised hepatic synthesis capacity.</p></div><div><h3>Discussion</h3><p>This case demonstrates the continued need for open visceral bypass surgery to ensure organ perfusion, if the latter depends on an aneurysmal artery. In such a situation, visceral bypass surgery can be considered in challenging anatomical scenarios, which demonstrates the relevance of endovascular and open procedures. In conclusion, both procedures can be combined in individualised therapy approaches to maximise patient benefit.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 25-29"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000960/pdfft?md5=15cef10ecddb49a86874c3a960be6183&pid=1-s2.0-S2666688X24000960-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695381","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}