EJVES Vascular Forum最新文献

{"title":"Maintenance of Functionality Without Flushing of Totally Implantable Venous Access Devices: A Presentation of Clinical Cases","authors":"Martina Rapisarda ,&nbsp;Luisa Gallo ,&nbsp;Alessandro Terrasi ,&nbsp;Ivan Lo Iacona ,&nbsp;Isidoro Di Carlo ,&nbsp;Adriana Toro","doi":"10.1016/j.ejvsvf.2025.05.005","DOIUrl":"10.1016/j.ejvsvf.2025.05.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to report experience of treating patients who underwent implantation of a long term totally implantable venous access device (TIVAD) that was not flushed.</div></div><div><h3>Methods</h3><div>Patients who underwent TIVAD implantation between 1995 and 2016 were included in the present study. Sex, age, type of disease, indications, surgeon, device used, choice of venous access, type of procedure, morbidity, and follow up duration were considered.</div></div><div><h3>Results</h3><div>Five hundred and forty-four patients underwent surgical TIVAD implantation. The most common type of disease was solid tumours (508 patients, 93,4%). In 503 patients, the TIVAD was implanted in the cephalic vein. Seven (1.3%) patients were diagnosed with tumour recurrence by an oncologist (5/7 male, median age 57 years). Four (57.1%) patients had recurrent colorectal cancer, and three (42.9%) had recurrent breast cancer. For several months, these patients did not return to the hospital for port flushing. None of these devices were heparinised for 18–24 months; however, no signs of occlusion were detected.</div></div><div><h3>Conclusion</h3><div>This study shows that TIVAD can remain patent without flushing. Moreover, the lack of flushing could be economically advantageous and could provide relief for patients. Therefore, a larger study of this topic is needed.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 24-27"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491043","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":"Iatrogenic Thoracic Aortic Injury Due to Right Intercostal Drain Insertion","authors":"Giulia Bertagna,&nbsp;Nicola Troisi","doi":"10.1016/j.ejvsvf.2025.03.002","DOIUrl":"10.1016/j.ejvsvf.2025.03.002","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Page 68"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828802","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":"Endovascular Aneurysm Sealing: Sealed, Signed, Disposed?","authors":"Martin Teraa,&nbsp;Joost A. van Herwaarden","doi":"10.1016/j.ejvsvf.2025.05.006","DOIUrl":"10.1016/j.ejvsvf.2025.05.006","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 47-48"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572915","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":"Emergency Repair of a Symptomatic Arch Aneurysm due to a Type B Aortic Dissection Using a Repurposed Three Vessel Branched Endograft","authors":"Prakash Saha,&nbsp;Mohamed H. Sayed,&nbsp;Said Abisi","doi":"10.1016/j.ejvsvf.2025.06.002","DOIUrl":"10.1016/j.ejvsvf.2025.06.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic endovascular aortic repair (TEVAR) has replaced open surgery for descending thoracic aortic pathology. Achieving a suitable proximal seal may necessitate hybrid repair involving cervical debranching, which carries risks. Alternatively, if a total endovascular solution is being attempted, parallel grafts or physician modified devices can be used. These have not, however, been designed specifically for this purpose. Branched thoracic endografts represent an evolution in stent graft design for the aortic arch. Single branched off the shelf designs are available, but multibranched designs are custom made, limiting their emergency use. Here, the successful use of a repurposed custom made triple branched endograft for a complicated acute type B aortic dissection (TBAD) with rapid false lumen expansion is reported.</div></div><div><h3>Report</h3><div>An 84 year old man presented with a three day history of chest pain and worsening breathlessness. He had had a previous episode of acute TBAD a month earlier, managed with blood pressure control. Computed tomography angiography (CTA) revealed a left pleural effusion and an aortic dissection extending from the left subclavian artery to the aortic bifurcation. The proximal descending aortic diameter had rapidly expanded to 67 mm. To treat the patient, a custom made triple branched endograft, initially intended for a different patient, was used. Follow up CTA showed satisfactory positioning of the stent graft with no evidence of endoleak, complete false lumen thrombosis, and satisfactory aortic remodelling.</div></div><div><h3>Discussion</h3><div>Acute TBAD remains a significant therapeutic challenge, especially when complications arise. TEVAR is recommended, but standard endografts may require full head and neck vessel debranching to ensure a proximal seal, which can be achieved by either open surgery or through endovascular means. This case demonstrates the applicability of a multibranched arch endograft in the emergency setting, which fortunately was available in the unit. Although these cases are rare, it is believed that development of a three vessel off the shelf solution should be considered.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 83-86"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007686","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":"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":"Objective Perfusion Assessment With Near Infrared Fluorescence for Guidance of Bowel Resection Margins Following Superior Mesenteric Artery Thrombosis: A Case Report","authors":"Roderick C. Peul,&nbsp;Floris P. Tange,&nbsp;Joost R. van der Vorst","doi":"10.1016/j.ejvsvf.2025.08.006","DOIUrl":"10.1016/j.ejvsvf.2025.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>Acute occlusion of the superior mesenteric artery (SMA) results in extensive bowel ischaemia, with mortality rates approaching 70%. Management involves acute revascularisation, typically via embolectomy, and intra-operative evaluation to distinguish viable from non-viable intestinal tissue. Near infrared fluorescence (NIRF) imaging with indocyanine green (ICG) enables real time, minimally invasive assessment of tissue perfusion. This case report illustrates the usability of NIRF imaging to guide surgical decision making for bowel preservation and patient survival in a clinical situation where research is limited.</div></div><div><h3>Report</h3><div>A 40 year old male presented, in June 2023, with severe postprandial abdominal pain. Imaging revealed a non-occlusive thrombus in the SMA, which together with clinical deterioration resulted in an emergency embolectomy. Intra-operative NIRF imaging with ICG identified malperfusion of a jejunal segment. A second NIRF assessment post-embolectomy confirmed persistent malperfusion, guiding resection with a primary anastomosis. Quantitative fluorescence analysis confirmed the intra-operative findings of malperfusion and demonstrated potential utility for objective perfusion assessment to resect non-viable tissue and limit viable tissue resection. The patient recovered uneventfully and was discharged on post-operative day five.</div></div><div><h3>Discussion</h3><div>This case highlights the use of NIRF imaging as a safe, low cost technique for evaluating bowel perfusion during SMA embolectomy. By selecting adjacent regions of interest, surgeons can compare objective perfusion curves intra-operatively and select optimal anastomosis sites. Quantified parameters further aid decision making, showing clear percentage differences in perfusion between viable and ischaemic tissue. Although standardised cut off values are lacking, combining clinical evaluation, subjective assessment, and quantitative data offers a patient tailored approach to optimising resection margins.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 186-189"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424682","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":"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":"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}