JVS-vascular insights最新文献

{"title":"Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review","authors":"Ajay Kumar Dabas DNB ,&nbsp;Vishal Singh DNB ,&nbsp;Brijesh Biswas DNB ,&nbsp;Manvendu Jha DNB ,&nbsp;Amit Agrawal DNB ,&nbsp;Amit Shah DNB ,&nbsp;Puneet Aggarwal DNB ,&nbsp;Aditya Gupta MCh ,&nbsp;Ajay Kumar Sharma MS, FRCS","doi":"10.1016/j.jvsvi.2025.100234","DOIUrl":"10.1016/j.jvsvi.2025.100234","url":null,"abstract":"<div><h3>Objective</h3><div>Anastomotic pseudoaneurysms (APs) in renal transplants are rare. Definite guidelines for its management are lacking. A case series and a technique of <em>in-vivo</em> cooling are presented, and the literature is reviewed to help making informed decisions.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of all the patients who developed APs following renal transplants done between 2013 and 2023. PubMed and Scopus were searched for key words: pseudoaneurysm, aneurysm, arteritis, rupture, renal-transplant, allograft, kidney, mycotic, and fungal/infective. APs or bleeding from transplanted renal artery or anastomosis were included. APs secondary to transplanted renal artery stenosis, intervention, adjacent organ infection, pregnancy, intrarenal pseudoaneurysms, multiorgan transplants, unknown donor status and non-functional grafts were excluded.</div></div><div><h3>Results</h3><div>Eight patients developed APs out of 714 transplants. The technique of <em>in vivo</em> cooling helped save one allograft. Six allografts were explanted. One patient died suddenly at home. After literature search, 199 cases were analyzed. One hundred sixty-four presented within 90 days of transplant (group A), 21 between 91 and 365 days (group B), and 14 after 365 days (group C). APs was evident in 111, and 88 presented with bleeding/hemorrhagic shock, including three deaths. Infective etiology was confirmed by histopathology or culture in 156 cases; Candida, Aspergillus, and Pseudomonas were the most common microbes. However, only 101 had clinical sepsis. Fifty-one had symptoms due to compression of adjacent artery/vein/nerve. Fifty-nine allografts (group A, 38; group B, 9; group C, 12) were saved out of 82 attempted. Nephrectomy with/without arterial reconstruction was done in 115, with recurrence in 26. There were 26 deaths, and all were in group A.</div></div><div><h3>Conclusions</h3><div>APs in renal transplants though rare, result in high mortality and graft loss. Most occur within a year of transplant. Despite infective etiology, features of sepsis can be absent. Recurrence is high following salvage attempt or nephrectomy.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098661","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":"Hybrid operating room transition in abdominal aortic aneurysm treatment: Impacts on operative outcomes and complications","authors":"Sara Sedillot-Daniel MD,&nbsp;Ievgen Gegiia MD,&nbsp;Julien Bernatchez MD, MMSc, MedEd,&nbsp;Annie Boisvert MD, MSc,&nbsp;Pascal Rheaume MD","doi":"10.1016/j.jvsvi.2025.100235","DOIUrl":"10.1016/j.jvsvi.2025.100235","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to explore whether performing endovascular aortic repair (EVAR) in a hybrid room (HR) has a benefit on radiation exposure, volume of contrast, postoperative renal insufficiency, and complication rate (endoleak, thrombosis, reoperation) in the long term compared with conventional rooms (CRs). A literature review was previously carried out to define the impact of this hybrid technology on interventional performance.</div></div><div><h3>Methods</h3><div>This retrospective study compared consecutive patients undergoing standard elective EVAR at Centre Hospitalier Universitaire de Quebec from December 2015 and September 2022, while transitionning to a hybrid endovascular room. Patients were divided into two groups: the CR group included EVARs performed in a conventional operating room with a mobile C-arm (December 2015 to November 2019), and the HR group included EVARs performed in a hybrid room using a fixed angiographic system (December 2019 to September 2022). Data analysed included radiation exposure (mGy) and contrast volume, fluoroscopy time, acute renal failure, endoleaks, limb thrombosis, and reintervention.</div></div><div><h3>Results</h3><div>A total of 314 patients were included (202 in the HR group and 112 in the CR group). Groups were comparable in demographic characteristics and comorbidities. Radiation exposure was significantly higher in the HR group (679.5 mGy) compared with the CR group (244.5 mGy) (<em>P</em> &lt; .001) without significant change in fluoroscopy time (<em>P</em> = .103). Contrast volume was equivalent between groups. However, the CR group presented with a higher rate of renal failure (5.4% vs 1%). Adjuvant procedures at the time of EVAR implantation were more frequent in the HR group. Their overall late reintervention rate did not differ significantly.</div></div><div><h3>Conclusions</h3><div>EVAR procedures performed in the hybrid suite at our center showed increased radiation exposure, partly attributable to more adjuvant procedures. It did not, however, have a significant impact on late outcomes.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124623","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":"Conus medullaris syndrome following abdominal aortic aneurysm repair","authors":"Prajna B. Kota MS, MCh ,&nbsp;Ashwitha Ravi MS, MRCS ,&nbsp;Prashant Jain MS ,&nbsp;Jineesh Valakkada MD ,&nbsp;Shivanesan Pitchai MS, MCh","doi":"10.1016/j.jvsvi.2025.100255","DOIUrl":"10.1016/j.jvsvi.2025.100255","url":null,"abstract":"<div><div>The conus medullaris is the lowermost end of the spinal cord. Conus medullaris syndrome, a subset of spinal cord ischemia has been observed as a clinical presentation and complication of aortic pathology. The incidence of spinal cord ischemia after abdominal aortic surgery ranges from 0.16% to 2.31%. Predisposing factors include a low-lying greater radicular artery, prolonged aortic cross-clamping, perioperative hypotension, embolization, and deficient pelvic circulation. In this paper, we present our experience with two patients who developed conus medullaris syndrome following abdominal aortic aneurysm repair and their clinical courses. We also review the existing literature to further our understanding of this rare occurrence, the outcomes of follow-up, early detection, and possible therapeutic options.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100255"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663158","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":"Narrative review on applications of artificial intelligence in vascular trauma","authors":"Zachary Tran MD ,&nbsp;Michael C. Wilkinson MD ,&nbsp;Glenn Guardamondo MD ,&nbsp;Mohamed H. El-Farra MD, MS ,&nbsp;Allan B. Peetz MD ,&nbsp;Roger T. Tomihama MD, MBA ,&nbsp;Sharon C. Kiang MD","doi":"10.1016/j.jvsvi.2025.100268","DOIUrl":"10.1016/j.jvsvi.2025.100268","url":null,"abstract":"<div><h3>Objective</h3><div>Artificial intelligence (AI) applications in vascular trauma are vast and revolutionizing the approach to patient care. AI has demonstrated to have potential to aid in complex medical decision-making across the continuum of trauma care from injury prognostication and prehospital triage, to initial evaluation and postoperative surveillance. AI’s transformative footprint is guiding the way in the era of “big data.” The present review seeks to provide a comprehensive overview of the current applications of AI in vascular trauma management, provide awareness for future directions in this field, and discuss limitations to its widespread adoption.</div></div><div><h3>Methods</h3><div>A narrative review of full text articles evaluating AI-based interventions in vascular trauma from inception to 2025 was performed.</div></div><div><h3>Results</h3><div>Our review focuses on the AI applications in vascular trauma in three specific domains of vascular trauma: blunt cerebrovascular injury, traumatic amputation and peripheral arterial injury, and blunt thoracic aortic injury. Present work thus far has focused on outcome prognostication compared with pre-existing and historic models. We also describe several studies that discuss leveraging AI’s strengths in identifying injury risk factors that may not be readily clinically apparent. Advances in computational surgery with the aid of AI in complex endovascular repair has improved precision that has seen promise in improving outcomes. Future applications of AI may help improve trauma resuscitation, access to care, and survivorship. Current limitations to widespread adoption include the need for integration into time-sensitive clinical care processes, lack of familiarity, and the required technical expertise to build and maintain AI models.</div></div><div><h3>Conclusions</h3><div>Current applications of AI in vascular trauma have demonstrated important utility to benefit patient care with a wide range of influence. As current barriers are addressed, clinicians can expect AI applications in vascular trauma to flourish and vascular trauma health care delivery to be more streamlined.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100268"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809869","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":"The future of vascular surgery and the general surgery resident","authors":"Kevin Leong MD ,&nbsp;Susan Basharkhah MD ,&nbsp;Jose Chavez MD ,&nbsp;Caili Pierro DO ,&nbsp;Rajesh Malik MD ,&nbsp;Nicole Ilonzo MD","doi":"10.1016/j.jvsvi.2024.100152","DOIUrl":"10.1016/j.jvsvi.2024.100152","url":null,"abstract":"<div><div>By 2030, there will be a shortage of approximately 400 vascular surgeons. Patients with vascular disease will rely heavily on nonvascular specialists, such as cardiologists, general surgeons, and advanced care providers, for care. It is imperative that general surgery residents are educated on vascular pathology to best meet the needs of patients with vascular disease.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143105202","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":"Detection of ischemia by a biosensor measuring tissue carbon dioxide tension","authors":"Johanne Korslund MD ,&nbsp;Rasmus D. Thorkildsen MD, PhD ,&nbsp;Espen Lindholm MD, PhD ,&nbsp;Runar Strand-Amundsen MS, PhD ,&nbsp;Tor Inge Tønnessen MD, PhD ,&nbsp;Magne Røkkum MD, PhD","doi":"10.1016/j.jvsvi.2024.100166","DOIUrl":"10.1016/j.jvsvi.2024.100166","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated a miniaturized biomedical sensor that can be inserted into any tissue or organ to measure partial gas pressure of carbon dioxide (pCO₂) and temperature continuously in real time. Numerous animal studies have shown that pCO₂ is a sensitive and specific marker of ischemia. The present study was designed to examine the feasibility and safety of the device in patients scheduled for limb orthopedic (arm/leg) surgery with tourniquet.</div></div><div><h3>Methods</h3><div>We performed an observational, prospective, cohort study at a single center in Norway. The primary and secondary endpoints were to evaluate the ability of the biosensor to measure pCO₂ and corresponding temperature levels in ischemic and nonischemic limb musculature and subcutaneous tissue. Additional secondary objectives were to assess the safety/efficacy of using the device.</div></div><div><h3>Results</h3><div>Forty-five patients received the sensor in this study from May 2021 to June 2022. The mean difference between the pCO₂ levels in ischemia and nonischemia limbs was 29.4 mmHg (95% confidence interval [CI], 25.8-33.0; <em>P</em> &lt; .001). When examining intramuscular tissue exclusively, the mean total difference between the pCO₂ levels in ischemic and nonischemic limb was 32.7 mmHg; 95% CI [27.5; 37.9], <em>P</em> &lt; .001. The mean difference between the temperature levels in intramuscular and subcutaneous tissue in ischemic and nonischemic limb was 2.5 ^oC (95% CI, 2.0-2.9; <em>P</em> &lt; .001) and 2.6 ^oC (95% CI, 2.1-3.2; <em>P</em> &lt; .001), respectively. Four patients experienced minor bleeding (less than 5 mL) during insertion of the sensors. No other bleeding was reported during the study period. None of the subjects experienced any kind of clinical infections/inflammations or pain (numeric rating scale score, 0) at the insertion sites during the entire study period. No serious adverse events related to the study procedure or device were noted.</div></div><div><h3>Conclusions</h3><div>The device provides a safe and dependable way to continuously and instantly track pCO₂ levels in muscular and subcutaneous tissues, thereby offering a means to detect and monitor ischemia.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135765","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":"Intercontinental variations in the presentation and management of venous thromboembolism","authors":"Cassius Iyad Ochoa Chaar MD, MS ,&nbsp;Shin Mei Chan MD ,&nbsp;Alfred I. Lee MD, PhD ,&nbsp;Behnood Bikdeli MD, MS ,&nbsp;Gregorio Tiberio MD, PhD ,&nbsp;Romain Chopard MD, PhD ,&nbsp;Ido Weinberg MD ,&nbsp;Yugo Yamashita MD, PhD ,&nbsp;Reza Nikandish MD ,&nbsp;Manuel Monreal MD, PhD","doi":"10.1016/j.jvsvi.2025.100201","DOIUrl":"10.1016/j.jvsvi.2025.100201","url":null,"abstract":"<div><h3>Objective</h3><div>Venous thromboembolism (VTE) is a global disease with significant morbidity and mortality. However, variations in presentation and management of VTE between different continents have not been studied. This retrospective analysis of prospectively collected registry data compares presenting symptoms and treatment modalities of patients with VTE in three continents: Europe, America, and Asia.</div></div><div><h3>Methods</h3><div>The data from the Registro Informatizado de la Enfermedad ThromboEmbólica registry (2011-2021) were reviewed. The Registro Informatizado de la Enfermedad ThromboEmbólica is the largest international registry dedicated to VTE that started in Spain and expanded worldwide. Patient characteristics and treatments were compared between Europe, America, and Asia using standardized differences.</div></div><div><h3>Results</h3><div>There were a total of 61,531 patients with VTE with the majority from Europe (90.3%), followed by Asia (6.3%) and America (3.3%). Patients diagnosed with VTE in America were significantly younger than the other continents. VTE patients in America were more likely to be Black and patients in Asia were more likely to have a lower body mass index when compared with patients from Europe and America. Patients with VTE in Asia presented with significantly more comorbidities including diabetes, coronary artery disease, and ischemic stroke. Also, patients from Asia were more likely to have recent major bleeding and active cancer. Conversely, patients from America had a significantly greater likelihood of having VTE related to travel. Anatomically, European patients were more likely to present with proximal DVT compared with patients from Asia and America. Patients in America were more likely to have low-risk pulmonary embolism (PE) and less likely to have intermediate-risk PE compared with patients from Europe and Asia. There was no difference in the proportion of patients with high-risk PE between continents. There was significant variation in the choice of initial and outpatient anticoagulation; vitamin K antagonists were more commonly used in Europe, whereas direct oral anticoagulants were more commonly used in America, and low-molecular-weight heparins were favored in Asia. Patients in Asia were less likely to receive systemic thrombolytic therapy. In terms of endovascular treatment, pharmacological thrombolysis was used more often for the treatment of PE in Europe compared with Asia and open pulmonary embolectomy was more common among American patients in the registry.</div></div><div><h3>Conclusions</h3><div>There is significant intercontinental variation in VTE presentation and management. Future analyses should evaluate the relationship of these variations with clinical outcomes. Comparative research using a global registry could shed light on VTE biology and treatment.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576687","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":"Development of a dry-lab vascular anastomosis training model using a surgical robot system","authors":"Takashi Endo MD, PhD,&nbsp;Toshio Takayama MD, PhD,&nbsp;Kazumasa Hanada MD, PhD,&nbsp;Masaru Kimura MD, PhD,&nbsp;Takuro Shirasu MD, PhD,&nbsp;Katsuyuki Hoshina MD, PhD","doi":"10.1016/j.jvsvi.2025.100202","DOIUrl":"10.1016/j.jvsvi.2025.100202","url":null,"abstract":"<div><h3>Objective</h3><div>Considering the wide variety of vascular diseases, searching for a less invasive treatment option in this field has always been challenging. Robotic technology can be a viable treatment option. This single-center, prospective analysis aimed to introduce a training model for robotic vascular anastomosis using a surgical robot system equipped with advanced multi-articulated arms. The study model sought to address the gap in training methodologies for robotic vascular anastomosis, facilitating the adoption of robotic techniques in vascular surgery.</div></div><div><h3>Methods</h3><div>We enlisted vascular surgeons to perform 6-mm vascular graft end-to-end anastomoses using the Hinotori Surgical Robot System (Medicaroid Corp). The quality of anastomosis was evaluated using our specialized web application. Parameters, including procedural time, stitch consistency, and symmetry, were compared immediately after initial training and after 10 hours of practice. A novel deep anastomosis simulator was also tested to compare robotic and conventional laparoscopic vascular anastomoses.</div></div><div><h3>Results</h3><div>This study included three vascular surgeons, all novices in both robotic and laparoscopic vascular anastomosis. The initial robotic anastomosis showed significant variations in anastomosis consistency and procedural time compared with hand-sewn methods; however, the quality of robotic anastomosis rapidly improved after 10 hours of practice. The robotic approach also demonstrated better anastomosis quality than the conventional laparoscopic approach in the deep anastomosis model.</div></div><div><h3>Conclusions</h3><div>The training model we developed effectively enabled vascular surgeons to perform high-quality robotic vascular anastomosis, even in complex scenarios. An effective dry-lab training model is inevitable to safely introduce robot-assisted vascular surgery to our daily practice.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816811","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":"Clincal outcomes of two endovenous radiofrequency ablation systems in the treatment of great saphenous vein insufficiency","authors":"Hongjie Guo MD ,&nbsp;Jichang Li MD ,&nbsp;Hao Yu PhD ,&nbsp;Yongqiang Wang M Eng ,&nbsp;Xiaoqing Wang M Eng ,&nbsp;Yanan Yu MSc ,&nbsp;Tianmin Li PhD ,&nbsp;Xingyu Shao BSc ,&nbsp;Jia Liu BMed, MPH ,&nbsp;Jianmin Li PhD","doi":"10.1016/j.jvsvi.2024.100159","DOIUrl":"10.1016/j.jvsvi.2024.100159","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the clinical effectiveness after radiofrequency ablation (RFA) of the great saphenous veins with the experimental or control systems in a prospective, randomized, controlled clinical trial.</div></div><div><h3>Methods</h3><div>Fifty-four patients with varicose veins had their unilateral limb treated with RFA and completed 6 months of follow-up. Preprocedural, intraprocedural, and follow-up data were collected and compared.</div></div><div><h3>Results</h3><div>Patients had a procedural success rate of 100% (defined as complete occlusion of the treated vein segment or a partial recanalization of &lt;5 cm), and no clinical complications were reported. The ablation time was 122.04 ± 29.69 seconds in the experimental group and 128.78 ± 37.04 seconds in the control group (<em>P</em> = .664). The treated vein length was 24.33 ± 5.54 cm in the experimental group and 24.50 ± 5.82 cm in the control group (<em>P</em> = .915). For Venous Clinical Severity Score, the experimental group decreased from 6.04 ± 2.56 to 1.48 ± 1.74 (<em>P &lt;</em> .05), and the control group decreased from 7.11 ± 3.17 to 1.41 ± 1.39 (<em>P</em> &lt; .05). Aberdeen Varicose Vein Questionnaire decreased from 8.44 ± 3.74 to 1.89 ± 2.04 in the experimental group and from 9.26 ± 3.44 to 1.59 ± 1.87 in the control group. At 6 months after RFA, both groups showed significant improvement with no significant difference between them.</div></div><div><h3>Conclusions</h3><div>The new system manifested comparable vein occlusion rate to the commonly used RFA system, and no device-related mild or serious adverse events were observed.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453330","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":"Exploration of abdominal aorta morphology for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement evaluation with an analysis of zone II anatomy and aortic branch diameters","authors":"Jan C. van de Voort MD ,&nbsp;Lise I.P. Duijvestijn BSc ,&nbsp;Boudewijn L.S. Borger van der Burg MD, PhD ,&nbsp;Rigo Hoencamp MD, PhD","doi":"10.1016/j.jvsvi.2025.100188","DOIUrl":"10.1016/j.jvsvi.2025.100188","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Resuscitative endovascular balloon occlusion of the aorta (REBOA) use closer to the point-of-trauma could reduce prehospital mortality by temporary controlling non-compressible truncal hemorrhage (NCTH). Reliable external anatomic landmarks or body surface reference points, such as mid-sternum for zone I, are not available for zone III balloon placement. In the absence of radiographic or ultrasound balloon position confirmation, unintentional zone II placement can therefore occur. Although evidence is limited, the concerns regarding possible zone II occlusion could hamper implementation of REBOA in prehospital settings as imaging guidance is not always available. The aim of this study was to provide an extensive overview of aortic anatomy with zone II morphology and aortic branch diameters in European patients without vascular disease history. Concurrently, multiple previously proposed REBOA insertion lengths were validated with comparison of accidental out of zone III error rates, extensiveness of unintentional zone II placements, and occlusion of the aortic branches.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Contrast enhanced computed tomography scans from 242 Dutch non-trauma patients (146 females; mean age, 46 years) were analyzed. Central luminal line distances, including skin depths, were measured from the bilateral common femoral artery access points (FAAPs) to the middle and boundaries of the aortic occlusion zones and proximal and distal origins of the visceral branches. Mean intravascular distances from the FAAPs to the levels of interest and branch diameters were determined for all combined sex and age-based subgroups. Subsequently, a 40-mm long balloon introduction simulation was performed to precisely determine the extensiveness and degree of zone II branch occlusion of earlier proposed REBOA insertion lengths.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean distance from the left and right FAAPs to mid-zone III ranged between 233 and 251 mm and 238 and 257 mm, respectively. Mean zone III length was 87 mm (females, 85.4 mm; males, 88.7 mm) with a maximum difference of 4 mm (4.7%) between the four subgroups. The right iliofemoral trajectory was 5 mm longer regardless of sex or age. Mean zone II length was 45 mm (females, 43.8 mm; males, 47.3 mm), with a maximum 6 mm difference (14.3%). The mean superior mesenteric artery and celiac trunk diameters were 11.4 and 11.2 mm in females and 12.7 and 11.9 mm in males, respectively. Up to the celiac trunk, 66% of the mean age-based elongation originated in the iliofemoral trajectory (6 of total 9 mm), regardless of insertion side. No statistically significant age-based differences were seen for the zone lengths or branch diameters. Unintentional zone II placement error rates up to 71% were observed for previously proposed fixed-distance insertion lengths, but the extensiveness of aortic branch occlusion varied. Partial iliac artery placement error rates varied between 0 an","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453333","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}