EJVES Vascular Forum最新文献

{"title":"Post-Implantation Syndrome Incidence After Secondary Endovascular Aortic Interventions","authors":"Tiago F. Ribeiro ,&nbsp;Rita Soares Ferreira ,&nbsp;Carlos Amaral ,&nbsp;Frederico Bastos Gonçalves ,&nbsp;Maria Emília Ferreira","doi":"10.1016/j.ejvsvf.2025.02.005","DOIUrl":"10.1016/j.ejvsvf.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>Post-implantation syndrome (PIS), a systemic inflammatory response following endovascular aneurysm repair (EVAR) is estimated to occur in approximately 30% of patients. It has been hypothesised to resemble a hypersensitivity reaction. A secondary exposure after a priming event could result in an altered risk and severity of PIS. This study aimed to determine the incidence and short-term clinical consequences of PIS after secondary endovascular aortic aneurysm interventions.</div></div><div><h3>Methods</h3><div>Single centre retrospective observational study. Between 2011 and 2022, all consecutive patients who underwent secondary elective endovascular aortic interventions following a primary elective EVAR, thoracic endovascular aneurysm repair, or fenestrated and branched EVAR were considered. Re-interventions occurring within the first 30 post-operative days were excluded. PIS was defined as tympanic temperature ≥38°C and C-reactive protein (CRP) &gt; 75 mg/L. Primary outcome was PIS incidence within three days. Secondary outcomes were short-term (30 days) outcomes and risk factors for PIS. Logistic regression analysis was performed to correct for confounders.</div></div><div><h3>Results</h3><div>Seventy nine secondary interventions in 71 patients who underwent elective primary repair were analysed. During secondary repair, shorter stent graft combinations (median 305 <em>vs.</em> 171 mm, <em>p</em> ≤ 0.001) were implanted. In addition, patients were older (70 <em>vs.</em> 73 years, <em>p</em> = 0.043) and more frequently taking statin (79.4 <em>vs.</em> 92.2%, <em>p</em> = 0.026) or antiplatelet agents (66.7 <em>vs.</em> 85.6 %, <em>p</em> = 0.010). Overall, PIS occurred in 24.0%, significantly lower following secondary repair (32.3% <em>vs.</em> 16.5%, <em>p</em> = 0.022, adjusted odds ratio 0.38, 95% confidence interval 0.16–0.89). There were no significant differences in highest recorded temperature (<em>p</em> = 0.25), days of fever (<em>p</em> = 0.44), CRP, or peak white blood cell count. CRP presented a more delayed elevation in secondary PIS.</div></div><div><h3>Conclusion</h3><div>After secondary endovascular aortic interventions, PIS incidence appears reduced compared with primary aortic repair. This should be interpreted with caution, in the context of procedural heterogeneity and limited number of cases. Further studies to confirm these findings and explore the underlying immunological mechanisms are required.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 34-41"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523660","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":"Indocyanine Green Fluorescence Angiography to Assess Tissue Perfusion Before Common Femoral Artery Aneurysm Ligation After Transfemoral Amputation","authors":"Steven J.G. Leeuwerke ,&nbsp;Harry G.M. Vaassen ,&nbsp;Robbert Meerwaldt","doi":"10.1016/j.ejvsvf.2025.01.003","DOIUrl":"10.1016/j.ejvsvf.2025.01.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The superiority of indocyanine green fluorescence angiography (ICG-FA) to the clinical eye alone to assess tissue perfusion has been demonstrated in various surgical fields. This short report demonstrates the <em>in vivo</em> use of ICG-FA to assess skin perfusion before ligating the external iliac artery (EIA) to exclude a common femoral artery (CFA) aneurysm.</div></div><div><h3>Report</h3><div>A 70-year-old man presented with a CFA aneurysm after a previous transfemoral amputation. Ligation of the EIA was proposed, but concerns about tissue perfusion warranted a careful approach. The CFA was exposed using an infra-inguinal incision. Intra-operative ICG inflow and washout patterns were semi-quantitatively analysed to assess dermal perfusion of the femoral stump before and after EIA clamping. Based on similar patterns, distal EIA ligation was performed without ischaemic complications.</div></div><div><h3>Conclusion</h3><div>Indocyanine green fluorescence angiography is a promising technique for <em>in vivo</em> assessment of tissue perfusion in peripheral arterial disease, but standardised protocols for perfusion quantification are required to more accurately predict tissue viability.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 41-44"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445674","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":"Recovery of EndoAnchors Using a Four Loop Vascular Retriever Snare: Adaptive Solutions for Adverse Events Related to Endovascular Material","authors":"Clara Raventós,&nbsp;Fabricio Barahona,&nbsp;Vicente Riambau","doi":"10.1016/j.ejvsvf.2025.05.004","DOIUrl":"10.1016/j.ejvsvf.2025.05.004","url":null,"abstract":"<div><h3>Introduction</h3><div>EndoAnchors are adjuncts used for the prevention and treatment of type I endoleak and graft migration in thoracic or abdominal endovascular aortic aneurysm repair in patients with a challenging aortic neck. They secure the stent graft mechanically to the aortic wall by means of metallic screws. Adverse events are infrequent; however, the most common ones are fracture and or dislodgment (0.3–0.9%) and applicator malfunction (0.3%), as observed in this case.</div></div><div><h3>Case</h3><div>A 77 year old woman showed symptoms of increasing interscapular chest pain for three months. A computed tomography angiography scan revealed a large and symptomatic ascending thoracic aortic aneurysm with extension to the arch and descending thoracic aorta. The patient was operated on urgently using a frozen elephant trunk technique, with pain cessation. The residual thoracic aneurysm was repaired six months later with two overlapped thoracic endografts placed 15 mm above the celiac trunk and distal EndoAnchors, an off label use, due to a severely angulated distal landing zone. During the seventh and last EndoAnchor deployment on an angulated surface, a malfunction of its applicator was detected, which caused EndoAnchor detachment and migration, flying into the aorta's lumen and landing close to the aortic wall below the graft. It was then trapped with a CloverSnare four loop vascular retriever (CookMedical, Bloomington, IL, USA), supported by an 8.5 F TourGuide steerable sheath. During extraction, it fractured into two pieces at the common iliac artery. The previous manoeuvre was repeated at this level, recovering the fractured piece. Final completion angiography showed a good result without endoleak. The immediate post-operative and follow up scans were uneventful.</div></div><div><h3>Conclusion</h3><div>EndoAnchor detachment is uncommon but when it does occur, it is a solvable issue and can be retrieved using a snare and extracted with the proper endovascular tools and expertise.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 66-70"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653435","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":"Preservation of One Anterior and One Posterior Internal Iliac Artery Branch in a Case of Bilateral Common and Internal Iliac Arterial Aneurysms","authors":"Anna Stene Hurtsén ,&nbsp;Artai Pirouzram ,&nbsp;Tal Hörer","doi":"10.1016/j.ejvsvf.2025.05.009","DOIUrl":"10.1016/j.ejvsvf.2025.05.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Endovascular treatment of iliac aneurysms with sparing of the internal iliac arterial circulation is feasible with iliac branch devices. However, insufficient distal seal with the endovascular devices on the market can be challenging. In this case, the anatomy was complex due to the extent of the aneurysms, and the available technical options were limited.</div></div><div><h3>Report</h3><div>A 65 year old man with aneurysms in the left common iliac (43 mm) and bilateral internal iliac arteries (right 41 mm; left 49 mm) was treated with an aortobi-iliac stent graft and bilateral iliac branch devices with extensions to opposing anterior (right) and posterior (left) branches of the internal iliac artery through staged interventions. At six weeks of follow up all treated aneurysms had decreased or were stable in size. Clinical signs of right sided gluteal claudication were evident at six weeks of follow up but no symptoms remained 20 weeks post-operatively.</div></div><div><h3>Discussion</h3><div>The presented case illustrates a technique to preserve pelvic circulation in a case of bilateral common and internal iliac arterial aneurysms. Extensions of the internal iliac limb of the iliac branch device, into the opposing anterior and posterior divisions of the internal iliac artery, may offer a strategy to reduce pelvic ischaemia in scenarios where the anatomy limits the use of standard iliac branch devices.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 71-74"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679696","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":"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":"Primary Intra-operative Embolisation During Urgent Parallel Graft Endovascular Repair in Paravisceral Symptomatic Aortic Pseudoaneurysm","authors":"Paolo Spath ,&nbsp;Federica Campana ,&nbsp;Enrico Gallitto ,&nbsp;Chiara Mascoli ,&nbsp;Stefania Caputo ,&nbsp;Rodolfo Pini ,&nbsp;Gianluca Faggioli ,&nbsp;Mauro Gargiulo","doi":"10.1016/j.ejvsvf.2024.11.001","DOIUrl":"10.1016/j.ejvsvf.2024.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>Paravisceral aortic lesions present significant challenges for endovascular treatment. This retrospective analysis of consecutively treated patients from April 2017 to June 2021 aimed to analyse the outcome of primary intra-operative embolisation of aortic complicated pseudoaneurysms and gutter channels during parallel graft (PG) repair of paravisceral symptomatic aortic pseudoaneurysms.</div></div><div><h3>Methods</h3><div>Patients with symptomatic pseudoaneurysms of the paravisceral aorta treated with PGs using chimney or periscope configurations were included. Thoracic endografts were positioned to exclude the aortic lesions. Coil embolisation of both the lesions and gutter channels was performed after graft deployment and prior to ballooning of the stent grafts. The primary endpoints were technical success (defined as exclusion of the pseudoaneurysm, target visceral vessel [TVV] patency, absence of gutter endoleaks) and clinical success (technical success + resolution of symptoms + absence of major adverse events) at 30 days. Secondary endpoints included overall survival, TVV patency, gutter endoleaks, and freedom from re-interventions during follow up.</div></div><div><h3>Results</h3><div>Six patients (four women) were treated for pseudoaneurysm rupture (three cases) and symptomatic aortic pseudoaneurysm (three cases) of the paravisceral aorta. The patients' anatomies were unsuitable for off the shelf devices and patients were all deemed to be at prohibitive surgical risk. A total of 15 TVVs were revascularised (comprising three coeliac arteries, five superior mesenteric arteries, and seven renal arteries) using 10 chimney and five periscope PGs. One coeliac artery was occluded. Seventy coils were deployed to embolise both the aortic ruptures and gutter channels. Both technical and clinical success rates were 100%. The median follow up was 17 months (IQR 5, 35), during which time three patients died due to non-aortic related causes. One coeliac artery (6%) was occluded, and no endoleak evidence was found.</div></div><div><h3>Conclusion</h3><div>Primary intra-operative embolisation during parallel graft endovascular repair of paravisceral symptomatic aortic pseudoaneurysms may be both safe and effective in excluding the pseudoaneurysm when other options are unavailable.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 1-10"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972448","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":"Collateral Vein Ligation for Arteriovenous Fistula Maturation: A Pilot Study","authors":"Bogdan Bratu ,&nbsp;Bettina Chenesseau ,&nbsp;Andreea Luchianov ,&nbsp;Salomé Kuntz ,&nbsp;Nabil Chakfé ,&nbsp;Anne Lejay","doi":"10.1016/j.ejvsvf.2025.03.001","DOIUrl":"10.1016/j.ejvsvf.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Native arteriovenous fistulae (AVF) may fail to achieve adequate blood flow or size for successful cannulation and dialysis. No clear strategy exists concerning the effectiveness of collateral vein ligation (CVL) to improve AVF maturation. The aim of this study was to evaluate the effectiveness of CVL in improving AVF maturation.</div></div><div><h3>Methods</h3><div>A retrospective study was performed, including all patients who underwent CVL for delayed AVF maturation between January 2023 and December 2023. Combined procedures, such as concomitant venous stenosis angioplasties, were excluded. Evolution of AVF flow after CVL compared with AVF flow before CVL was recorded. The primary endpoint was defined as successful maturation after CVL. The AVF was considered mature when it could be routinely cannulated for the total duration of dialysis, for at least six months.</div></div><div><h3>Results</h3><div>Median follow up was eleven months (range 6–14 months). CVL allowed successful maturation in five of the six patients, with a median AVF flow increase of 44%. In these five patients, sustained dialysis after CVL was uneventful, without need for any additional interventions.</div></div><div><h3>Conclusion</h3><div>These results highlight the potential effectiveness of CVL in improving AVF maturation, although larger studies are needed to confirm these findings.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 69-72"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864227","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":"More Reasons to Submit to the EJVES Vascular Forum: A Look Through 2024 into 2025","authors":"Arindam Chaudhuri,&nbsp;Francisco Alvarez Marcos","doi":"10.1016/j.ejvsvf.2025.02.002","DOIUrl":"10.1016/j.ejvsvf.2025.02.002","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 65-67"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808251","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":"“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}