Seminars in Vascular Surgery最新文献

{"title":"Emergent endovascular treatment options for thoracoabdominal aortic aneurysm","authors":"Alessandro Grandi ,&nbsp;Andrea Melloni ,&nbsp;Mario D'Oria ,&nbsp;Sandro Lepidi ,&nbsp;Stefano Bonardelli ,&nbsp;Tilo Kölbel ,&nbsp;Luca Bertoglio","doi":"10.1053/j.semvascsurg.2023.04.004","DOIUrl":"10.1053/j.semvascsurg.2023.04.004","url":null,"abstract":"<div><p>For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured thoracoabdominal aortic aneurysm, offered mixed results, and depended mainly on the operator's and center's experience. As custom-made devices have become an established endovascular treatment option for elective thoracoabdominal aortic aneurysm, they are not a viable option in the emergency setting, as endograft production can take up to 4 months. The development of off-the-shelf (OTS) multibranched devices with a standardized configuration has allowed the treatment of ruptured thoracoabdominal aortic aneurysm with emergent branched endovascular procedures. The Zenith t-Branch device (Cook Medical) was the first readily available graft outside the United States to receive the CE mark (in 2012) and is currently the most studied device for those indications. A new device, the E-nside thoracoabdominal branch endoprosthesis OTS multibranched endograft (Artivion), has been made commercially available, and the GORE EXCLUDER thoracoabdominal branch endoprosthesis OTS multibranched endograft (W. L. Gore and Associates) is expected to be released in 2023. Due to the lack of guidelines on ruptured thoracoabdominal aortic aneurysm, this review summarizes the available treatment options (ie, parallel grafts, physician-modified endografts, in situ fenestrations, and OTS multibranched devices), compares the indications and contraindications, and points out the evidence gaps that should be filled in the next decade.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9715284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major vascular traumas to the neck, upper limbs, and chest: Clinical presentation, diagnostic approach, and management strategies","authors":"Giovanni Badalamenti ,&nbsp;Ciro Ferrer ,&nbsp;Cristiano Calvagna ,&nbsp;Marco Franchin ,&nbsp;Gabriele Piffaretti ,&nbsp;Jacopo Taglialavoro ,&nbsp;Silvia Bassini ,&nbsp;Filippo Griselli ,&nbsp;Beatrice Grando ,&nbsp;Sandro Lepidi ,&nbsp;Mario D'Oria","doi":"10.1053/j.semvascsurg.2023.04.010","DOIUrl":"10.1053/j.semvascsurg.2023.04.010","url":null,"abstract":"<div><p>Major vascular traumas to the neck, upper limbs, and chest may arise from penetrating and/or blunt mechanisms, resulting in a range of clinical scenarios. Lesions to the carotid arteries may also lead to neurologic complications, such as stroke. The increasing use of invasive arterial access for diagnostic and/or interventional purposes has increased the rate of iatrogenic injuries, which usually occur in older and hospitalized patients. Bleeding control and restoration of perfusion represent the two main goals of treatment for vascular traumatic lesions. Open surgery still represents the gold standard for most lesions, although endovascular approaches have increasingly emerged as feasible and effective options, particularly for management of subclavian and aortic injuries. In addition to advanced imaging (including ultrasound, contrast-enhanced cross-sectional imaging, and arteriography) and life support measures, multidisciplinary care is required, particularly in the setting of concomitant injuries to the bones, soft tissues, or other vital organs. Modern vascular surgeons should be familiar with the whole armamentarium of open and endovascular techniques needed to manage major vascular traumas safely and promptly.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9715752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency vascular surgical care in populations with unique physiologic characteristics: Pediatric, pregnant, and frail populations","authors":"David Warner ,&nbsp;Kathryn W. Holmes ,&nbsp;Rana Afifi ,&nbsp;Melissa L. Russo ,&nbsp;Sherene Shalhub","doi":"10.1053/j.semvascsurg.2023.04.015","DOIUrl":"10.1053/j.semvascsurg.2023.04.015","url":null,"abstract":"<div><p><span>Vascular surgical emergencies are common in vascular surgical care and require complex decision making and multidisciplinary care. They are especially challenging when they occur in patients<span> with unique physiological characteristics, such as pediatric, pregnant, and frail patients. Among the pediatric and pregnant population, vascular emergencies are rare. This rarity challenges accurate and timely diagnosis of the vascular emergency. This landscape review summarizes these three unique populations' </span></span>epidemiology and emergency vascular considerations. Understanding the epidemiology is the foundation for accurate diagnosis and subsequent management. Considering each population's unique characteristics is crucial to the emergent vascular surgical interventions decision making. Collaborative and multidisciplinary care is vital in gaining expertise in managing these special populations and achieving optimal patient outcomes.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe local wound infections after vascular exposure in the groin and other body areas: Prevention, treatment and prognosis","authors":"Marta Minucci ,&nbsp;Tommaso Donati ,&nbsp;Antonio Luparelli,&nbsp;Lucia Scurto,&nbsp;Julia Paolini,&nbsp;Simona Sica,&nbsp;Marco Natola,&nbsp;Fabrizio Minelli,&nbsp;Yamume Tshomba,&nbsp;Giovanni Tinelli","doi":"10.1053/j.semvascsurg.2023.04.014","DOIUrl":"10.1053/j.semvascsurg.2023.04.014","url":null,"abstract":"<div><p>Severe surgical site infections (SSIs) are a frequent nosocomial complication after vascular interventions, an important cause of postoperative morbidity, and a substantial burden to the health care system. Patients undergoing arterial interventions are at elevated risk of SSIs, possibly because of the presence of several risk factors in this patient population. In this review, we examined the available clinical evidence for the prevention, treatment, and prognostication of postoperative severe SSIs after vascular exposure in the groin and other body areas. Results from studies evaluating preoperative, intraoperative, and postoperative preventive strategies and several treatment options are reviewed. In addition, risk factors for surgical wound infections are analyzed in detail and related evidence from the literature is highlighted. Although several measures have been implemented over the time to prevent them, SSIs continue to pose a substantial health care and socioeconomic challenge. Therefore, strategies to decrease the risk and improve the treatment of SSIs for the high-risk vascular patient population should be the focus of continuing improvement and critical review. This review aimed at identifying and reviewing the current evidence for preventing, treating, and performing stratification according to the prognosis of postoperative severe SSIs after vascular exposure in the groin and other body areas.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mature AI/ML-Enabled Medical Tools Impacting Vascular Surgical Care: A scoping review of late-stage, FDA approved/cleared technologies relevant to vascular surgeons","authors":"David P. Stonko, C. Hicks","doi":"10.1053/j.semvascsurg.2023.06.001","DOIUrl":"https://doi.org/10.1053/j.semvascsurg.2023.06.001","url":null,"abstract":"Artificial intelligence and machine learning (AI/ML)-enabled tools are shifting from theoretical or research-only applications to mature, clinically useful tools. The goal of this article was to provide a scoping review of the most mature AI/ML-enabled technologies reviewed and cleared by the US Food and Drug Administration relevant to the field of vascular surgery. Despite decades of slow progress, this landscape is now evolving rapidly, with more than 100 AI/ML-powered tools being approved by the US Food and Drug Administration each year. Within the field of vascular surgery specifically, this review identified 17 companies with mature technologies that have at least one US Food and Drug Administration clearance, all occurring between 2016 and 2022. The maturation of these technologies appears to be accelerating, with improving regulatory clarity and clinical uptake. The early AI/ML-powered devices extend or amplify clinically entrenched platform technologies and tend to be focused on the diagnosis or evaluation of time-sensitive, clinically important pathologies (eg, reading Digital Imaging and Communications in Medicine-compliant computed tomography images to identify pulmonary embolism), or when physician efficiency or time savings is improved (eg, preoperative planning and intraoperative guidance). The majority (>75%) of these technologies are at the intersection of radiology and vascular surgery. It is becoming increasingly important that the contemporary vascular surgeon understands this shifting paradigm, as these once-nascent technologies are finally maturing and will be encountered with increasingly regularity in daily clinical practice.","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46777706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary multimodal approach to diagnosis and treatment of vascular graft and endograft infections","authors":"Lau Røge Jepsen ,&nbsp;Karl Sörelius ,&nbsp;Reshaabi Srinanthalogen ,&nbsp;Jacob Budtz-Lilly","doi":"10.1053/j.semvascsurg.2023.03.006","DOIUrl":"10.1053/j.semvascsurg.2023.03.006","url":null,"abstract":"<div><p>Vascular graft and endograft infections <strong>(</strong>VGEIs) are a feared complication because of their morbidity, cost, and mortality. Despite broad and varying strategies, as well as limited evidence, societal guidelines do exist. The objective of this review was to supplement current guidelines with emerging and multimodal techniques for treatment. An electronic search was performed using PubMed with specific search terms from 2019 to 2022 in which VGEIs were described or analyzed in the carotid, thoracic aorta, abdominal, or lower extremity arteries. A total of 12 studies were collected from the electronic search. Articles describing all of the anatomic areas were present. The incidence of VGEIs depends on the anatomic location, varying from &lt;1% to 18%. Gram-positive bacteria are the most common organism. Referral of patients with VGEIs to centers of excellence is paramount, as is pathogen identification, preferably from direct sampling techniques. The MAGIC (Management of Aortic Graft Infection Collaboration) criteria have been endorsed for all VGEIs and validated for aortic VGEI. They are well supplemented with additional diagnostic techniques. Treatment must be individualized, although the goal should be the removal of infected material with appropriate revascularization. VGEIs remain a devastating complication, despite changing or improving medical surgical techniques in vascular surgery. Prophylactic measures, early diagnosis, and patient-specific therapy remain the cornerstones of treatment for this feared complication.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10017418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute ischemia of the upper and lower limbs: Tailoring the treatment to the underlying etiology","authors":"Ciro Ferrer,&nbsp;Giulia Antonietta Cannizzaro,&nbsp;Adelaide Borlizzi,&nbsp;Cataldo Caruso,&nbsp;Rocco Giudice","doi":"10.1053/j.semvascsurg.2023.04.006","DOIUrl":"10.1053/j.semvascsurg.2023.04.006","url":null,"abstract":"<div><p><span><span>Acute limb ischemia (ALI) can be a devastating clinical emergency with potentially limb- or life-threatening consequences. It is defined as a quickly developing or sudden decrease in </span>limb perfusion<span><span><span> producing new or worsening symptoms and signs, often threatening limb viability. ALI is commonly related to an acute arterial occlusion<span>. Rarely, extensive venous occlusion can lead to upper and </span></span>lower extremities ischemia (ie, phlegmasia). The incidence of acute peripheral arterial occlusion causing ALI is approximately 1.5 cases per 10,000 people per year. The clinical presentation depends on the etiology and whether the patient has underlying </span>peripheral artery disease. Except for traumas, the most common etiologies are embolic or thrombotic events. Peripheral embolism, likely related to embolic heart disease, is the most common cause of acute upper extremity ischemia. However, an acute thrombotic event may occur in native arteries, at the site of a pre-existing atherosclerotic plaque, or as a failure of previous vascular interventions. The presence of an aneurysm may predispose to ALI for both embolic and thrombotic mechanisms. Immediate diagnosis, accurate assessment of limb viability, and prompt intervention, when needed, play important roles in salvaging the affected limb and preventing major amputation. Severity of symptoms is usually dependent on the amount of surrounding arterial </span></span>collateralization<span><span>, which may often reflect a pre-existing chronic vascular disease. For this reason, early recognition of the underlying etiology is crucial for choice of best management and definitely for treatment success. Any error in the initial evaluation may negatively affect the functional prognosis of the limb and endanger the patient's life. The aim of this article was to discuss diagnosis, etiology, </span>pathophysiology, and treatment of patients with acute ischemia of the upper and lower limbs.</span></p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10017421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ruptured abdominal aorto-iliac aneurysms: Diagnosis, treatment, abdominal compartment syndrome, and role of simulation-based training","authors":"Anna-Leonie Menges ,&nbsp;Mario D`Oria ,&nbsp;Alexander Zimmermann ,&nbsp;Philip Dueppers","doi":"10.1053/j.semvascsurg.2023.03.002","DOIUrl":"10.1053/j.semvascsurg.2023.03.002","url":null,"abstract":"<div><p>Ruptured abdominal aortic aneurysms (rAAA), with or without iliac involvement, are a life-threatening scenario with high mortality even after surgical therapy. Several factors have contributed to improving perioperative outcomes in recent years, including the progressive use of endovascular aortic repair (EVAR) and intraoperative balloon occlusion of the aorta, a dedicated treatment algorithm with centralization of care to high-volume centres, and optimized perioperative management protocols. Nowadays, EVAR is applicable in the majority of scenarios even in the emergency setting. Among the factors that influence the postoperative course of rAAA patients, abdominal compartment syndrome (ACS) is a rare but life-threatening complication. As its early clinical diagnosis is often missed but crucial to initiate an emergent surgical decompression therapy, dedicated surveillance protocols and transvesical measurement of the intraabdominal pressure are key for prompt diagnosis and immediate treatment of ACS. Further improvement of rAAA patients’ outcome may be achieved by the implementation of simulation-based training (of both technical and non-technical skills for surgeons as well as all involved healthcare personnel in multidisciplinary teams) and by transfer of all rAAA patients to specialized vascular centres with advanced experience and high caseload.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9715754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential applications of artificial intelligence (AI) and machine learning (ML) on diagnosis, treatment, outcome prediction to address health care disparities of chronic limb-threatening ischemia (CLTI)","authors":"Amirbehzad Bagheri, Mohammad Dehghan Rouzi, Navid Alemi Koohbanani, M. Mahoor, MG Finco, Myeounggon Lee, B. Najafi, Jayer Chung","doi":"10.1053/j.semvascsurg.2023.06.003","DOIUrl":"https://doi.org/10.1053/j.semvascsurg.2023.06.003","url":null,"abstract":"Chronic limb-threatening ischemia (CLTI) is the most advanced form of peripheral artery disease. CLTI has an extremely poor prognosis and is associated with considerable risk of major amputation, cardiac morbidity, mortality, and poor quality of life. Early diagnosis and targeted treatment of CLTI is critical for improving patient's prognosis. However, this objective has proven elusive, time-consuming, and challenging due to existing health care disparities among patients. In this article, we reviewed how artificial intelligence (AI) and machine learning (ML) can be helpful to accurately diagnose, improve outcome prediction, and identify disparities in the treatment of CLTI. We demonstrate the importance of AI/ML approaches for management of these patients and how available data could be used for computer-guided interventions. Although AI/ML applications to mitigate health care disparities in CLTI are in their infancy, we also highlighted specific AI/ML methods that show potential for addressing health care disparities in CLTI.","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45834884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute venous problems: Integrating medical, surgical, and interventional treatments","authors":"Daniele Bissacco ,&nbsp;Tim J. Mandigers ,&nbsp;Silvia Romagnoli ,&nbsp;Tiziana Aprea ,&nbsp;Chiara Lomazzi ,&nbsp;Ilenia D'Alessio ,&nbsp;Velio Ascenti ,&nbsp;Anna Maria Ierardi ,&nbsp;Maurizio Domanin ,&nbsp;Valerio Stefano Tolva ,&nbsp;Gianpaolo Carrafiello ,&nbsp;Santi Trimarchi","doi":"10.1053/j.semvascsurg.2023.04.013","DOIUrl":"10.1053/j.semvascsurg.2023.04.013","url":null,"abstract":"<div><p>“Acute venous problems” refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment.</p><p>Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.</p></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}