European Journal of Vascular and Endovascular Surgery最新文献

{"title":"The Impact of Target Vessel Anatomy and Bridging Stent Geometry on Branched Endovascular Aortic Repair Outcomes","authors":"","doi":"10.1016/j.ejvs.2024.04.028","DOIUrl":"10.1016/j.ejvs.2024.04.028","url":null,"abstract":"<div><h3>Objective</h3><p><span>This study aimed to evaluate the impact of target vessel anatomy and bridging stent geometry on target vessel instability in branched </span>endovascular aortic repair (B-EVAR).</p></div><div><h3>Methods</h3><p><span>This retrospective, single centre cohort study included all consecutive B-EVARs performed between September 2018 and December 2022 for thoraco-abdominal aortic aneurysm (TAAA) or complex </span>abdominal aortic aneurysm (CAAA). The primary endpoints were target vessel instability and related re-interventions at 12 months. Secondary endpoints were 30 day results, including target vessel instability and re-interventions. Target vessel instability analysis consisted of assessment of target vessel anatomy, including diameter, aortic trunk to branch angle, and tortuosity. Post-operative parameters included change of clock position/horizontal misalignment, bridging length (gap), sealing length, tortuosity, post-stenting angle, and oversizing ratio.</p></div><div><h3>Results</h3><p>A total of 69 patients (TAAA: <em>n</em> = 56, 81%; CAAA: <em>n</em><span> = 13, 19%) and 271 (133 visceral and 138 renal) target vessels were included. The cumulative incidence of target vessel instability was 4.8%, 6.4%, and 7.9% at one, two, and three years, respectively. In the renal target vessel group, vessel diameter ≤ 4 mm (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.116 – 2.54; </span><em>p</em> = .022) and a bridging length ≥ 25 mm (HR 1.320, 95% CI 1.066 – 1.636; <em>p</em> = .011) were associated with increased target vessel instability. In visceral vessels, a change in clock position/horizontal misalignment ≥ 70 minutes (HR 1.072, 95% CI 1.026 – 1.121; <em>p</em> = .002) showed a significant association with target vessel instability.</p></div><div><h3>Conclusion</h3><p>Target vessel diameter, bridging length (gap), and horizontal misalignment seemed to be associated with adverse target vessel outcomes. This may be solved with more customised endograft solutions to reduce the negative impact of the latter parameter.</p></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review and Meta-analysis of the Impact of Surgeon–Physician Co-management Models on Short Term Outcomes for Vascular Surgery Inpatients☆","authors":"","doi":"10.1016/j.ejvs.2024.05.005","DOIUrl":"10.1016/j.ejvs.2024.05.005","url":null,"abstract":"<div><h3>Objective</h3><p>As the population ages, vascular surgeons are treating progressively older, multimorbid patients at risk of peri-operative complications. An embedded physician has been shown to improve outcomes in general and orthopaedic surgery. This systematic review and meta-analysis aimed to investigate the impact of surgeon–physician co-management models on morbidity and mortality rates in vascular inpatients.</p></div><div><h3>Data Sources</h3><p>PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries.</p></div><div><h3>Review Methods</h3><p>Studies comparing adult vascular surgery inpatients under co-management with standard of care were eligible. The relative risks (RRs) of death, medical complications, and 30 day re-admission between co-management and standard care were calculated. The effect of co-management on the mean length of stay was calculated using weighted means. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies, and certainty assessment with the GRADE analysis tools.</p></div><div><h3>Results</h3><p><span>No randomised controlled trials were identified. Eight single institution studies between 2011 and 2020 with 7 410 patients were included. All studies were observational using before–after methodology. Studies were of high to moderate risk of bias, and outcomes were of very low GRADE certainty of evidence. Co-management was associated with a statistically significant lower relative risk of death (RR 0.64, 95% confidence interval [CI] 0.44 – 0.92; </span><em>p</em> = .02), cardiac complications (RR 0.47, 95% CI 0.25 – 0.87; <em>p</em> = .02), and infective complications (RR 0.49, 95% CI 0.35 – 0.67; <em>p</em> &lt; .001) in vascular inpatients. No statistically significant differences in length of stay (standard mean difference –0.6 days, 95% CI –1.44 – 0.24 days; <em>p</em> = .16) and 30 day re-admission (RR 0.96, 95% CI 0.84 – 1.08; <em>p</em> = .49) were noted.</p></div><div><h3>Conclusion</h3><p>Early results of physician and surgeon co-management for vascular surgery inpatients showed promising results from very low certainty data. Further well designed, prospective studies are needed to determine how to maximise the impact of physicians within a vascular service to improve patient outcomes while using hospital resources effectively.</p></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon–Physician Co-management for Vascular Surgery in Patients: In Need of Data Multiplication or Practice Implementation?","authors":"","doi":"10.1016/j.ejvs.2024.05.035","DOIUrl":"10.1016/j.ejvs.2024.05.035","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade's experience with retrograde open mesenteric stenting for acute mesenteric ischemia","authors":"","doi":"10.1016/j.ejvs.2024.08.018","DOIUrl":"10.1016/j.ejvs.2024.08.018","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury","authors":"","doi":"10.1016/j.ejvs.2024.08.015","DOIUrl":"10.1016/j.ejvs.2024.08.015","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence, predictors, and management of late vascular complications following extracorporeal membrane oxygenation","authors":"","doi":"10.1016/j.ejvs.2024.08.019","DOIUrl":"10.1016/j.ejvs.2024.08.019","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Choice – A Core Outcome Set for Intact Abdominal Aortic Aneurysm Repair","authors":"","doi":"10.1016/j.ejvs.2024.04.029","DOIUrl":"10.1016/j.ejvs.2024.04.029","url":null,"abstract":"<div><h3>Objective</h3><p>Technology and advances in clinical care have changed the management of abdominal aortic aneurysms (AAAs) but the clinical effectiveness of continuing advances needs to be assessed. To facilitate rapid synthesis of new evidence and improve stakeholder representation, including patients, the concept of core outcome sets (COS) has been developed. COS, reflecting the needs of all stakeholders, have been established across several surgical specialties. This study aimed to develop an international core outcome set for intact AAA repair.</p></div><div><h3>Methods</h3><p>Following COMET methodology, potential outcomes were identified from a systematic review of published outcomes and focus groups involving patients, carers, and nurses. A 38 question Delphi consensus survey in lay language was developed (with translation to local languages); this included 35 themes identified from the findings of the systematic review and three themes from the focus groups. All three of the themes identified by the focus groups (cognitive, physical, and social functioning) can be evaluated from quality of life instruments, with overall quality of life being identified from the systematic review. The survey was completed by patients, carers or family members, vascular nurses, vascular surgeons, trainees, interventional radiologists, anaesthetists, and industry partners from six European countries. After two rounds of the survey, the top outcomes were discussed at a face to face multistakeholder consensus meeting.</p></div><div><h3>Results</h3><p>The 38 item questionnaire was amended after piloting among all stakeholder groups. After the first round of the Delphi survey (98 respondents) 15 questions were eliminated, and 11 further questions were eliminated after round 2 (90 respondents). This left two outcome questions for discussion at the consensus meeting, where the top six outcomes were unanimously endorsed: death at 30 days (or in hospital if longer), secondary AAA rupture, overall quality of life and retention of cognitive functioning after recovery, five year survival, and continued sac growth.</p></div><div><h3>Conclusion</h3><p>Six core outcomes are recommended for use as a minimum framework in all future studies and registries of intact open and endovascular AAA repair. Further work to select instruments for quality of life and to define instruments for cognitive functioning is needed.</p></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1078588424003654/pdfft?md5=e164d0a0c2fb1dadce32186f1166c47f&pid=1-s2.0-S1078588424003654-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metachronous Kidney Autotransplantation in a Patient with Fibromuscular Dysplasia","authors":"","doi":"10.1016/j.ejvs.2024.04.010","DOIUrl":"10.1016/j.ejvs.2024.04.010","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing clinical outcomes of vitamin K antagonists vs non-vitamin K antagonists in anticoagulant therapy for mesenteric venous thrombosis","authors":"","doi":"10.1016/j.ejvs.2024.08.021","DOIUrl":"10.1016/j.ejvs.2024.08.021","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Comparative Analysis of Branched and Fenestrated Endovascular Aortic Arch Repair Outcomes","authors":"","doi":"10.1016/j.ejvs.2024.04.030","DOIUrl":"10.1016/j.ejvs.2024.04.030","url":null,"abstract":"<div><h3>Objective</h3><p>Female sex is a risk factor for adverse events after endovascular aortic repair. Sex comparative early and midterm outcomes of fenestrated and branched endovascular aortic arch repair (F/B-Arch) are presented.</p></div><div><h3>Methods</h3><p>A single centre retrospective sex comparative analysis of consecutive patients managed with F/B-Arch was conducted according to STROBE. Primary outcomes were sex comparative technical success, death, and cerebrovascular morbidity at 30 days. Kaplan–Meier estimates were used for follow up outcomes.</p></div><div><h3>Results</h3><p>Among 209 patients, 38.3% were women. Coronary artery disease (<em>p</em> &lt; .001) and previous myocardial infarction (<em>p</em> = .01) were more common in women. Non-native proximal aortic landing was higher in women (women: 51.3%; men: 31.8%, <em>p</em> = .005) and the aortic dissection rate was lower (28.8% <em>vs</em>. 48.1%, <em>p</em> = .005). Proximal landing to Ishimaru zones showed no difference (zone 0: <em>p</em> = .18; zone 1: <em>p</em> = .47; zone 2: <em>p</em> = .39). Graft configurations were equally distributed. In total, 416 supra-aortic trunks were bridged. The median number of revascularisations per patient was two (interquartile range 1, 3), with no difference between sexes (<em>p</em> = .54). Technical success (women: 97.5%; men: 96.9%, <em>p</em> = .80), 30 day mortality rate (women: 10%; men: 9.3%, <em>p</em> = .86), and cerebrovascular morbidity (women: 11.3%; men: 17.1%, <em>p</em> = .25) were similar. Women presented more access related complications (women: 32.5%; men: 16.3%, <em>p</em> = .006), without affecting access related re-interventions (<em>p</em> = .55). Survival (women: 81.1%, 95% confidence interval [CI] 76.3 – 85.9%; men: 79.8%, 95% CI 76.0 – 83.6%) and freedom from re-intervention (women: 56.6%, 95% CI 50.4 – 62.8%; men: 55.3%, 95% CI 50.1 – 60.5%) at 12 months were similar (log rank, <em>p</em> = .40 and <em>p</em> = .41, respectively).</p></div><div><h3>Conclusion</h3><p>Both sexes presented similar outcomes after F/B-Arch. Appropriate patient selection may decrease the effect of sex in F/B-Arch outcomes.</p></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1078588424003666/pdfft?md5=e53d8e003a79884735a65e11bba7f41d&pid=1-s2.0-S1078588424003666-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}