JVS-vascular insights最新文献

{"title":"A nonsystematic review of the early, mid-term, and long-term outcomes for fenestrated and branched endovascular repair of thoracoabdominal aneurysms","authors":"","doi":"10.1016/j.jvsvi.2024.100110","DOIUrl":"10.1016/j.jvsvi.2024.100110","url":null,"abstract":"<div><h3>Background</h3><p>Over the last two decades, the development of fenestrated and branched aortic endografts (F/BEVAR) has enabled endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) in high surgical risk patients. F/BEVAR has demonstrated acceptable early and mid-term outcomes; however, challenges include bridging stent instability and a high rate of reinterventions. Evaluating the long-term outcomes and durability of F/BEVAR is important for broader application of this technology.</p></div><div><h3>Methods</h3><p>We conducted a comprehensive, nonsystematic review of the literature reporting on the early, mid-term, and earl-long term outcomes for branched and fenestrated endovascular repair of TAAAs. The authors achieved consensus on the studies reviewed. Studies were evaluated based on the type and extent of aneurysms treated, long-term mortality, reintervention, and branch graft instability, although no pooled data analysis was performed.</p></div><div><h3>Results</h3><p>Retrospective cohort studies have reported a short-term mortality benefit for F/BEVAR in anatomically suitable high surgical risk patients. In the studies reviewed, the overall survival rate after FEVAR ranged from 81% to 100% at 1 year, 32% to 76% at 5 years, and 33% to 52% at 7 years. Freedom from reintervention after FEVAR ranged from 38% to 91% at 3 years and 50%% to 80% at 5 years. Bridging stent graft instability resulting in endoleak remain a significant clinical challenge and a primary driver of reintervention. Reports of target vessel patency ranged 89% to 96% at 3 years, and 86% to 99% at 5 years.</p></div><div><h3>Conclusions</h3><p>TAAAs present a challenging pathology associated with significant morbidity and mortality after surgical repair. Fenestrated and branched endovascular repair has enabled minimally invasive repair in high surgical risk patients and has demonstrated acceptable short- and mid-term outcomes including an early survival benefit, and a low rate of aortic-related mortality. F/BEVAR has also been associated with a higher rate of long-term reinterventions. Main body endoleak from progressive degeneration and branch graft instability have emerged as the primary drivers of long-term reinterventions.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000588/pdfft?md5=221f339d388ffabba0bf1aa61c1991d9&pid=1-s2.0-S2949912724000588-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141389934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review on endovascular false lumen management options in chronic aortic dissection","authors":"Petroula Nana PhD ,&nbsp;Ahmed Eleshra MD ,&nbsp;José I. Torrealba MD ,&nbsp;Giuseppe Panuccio PhD ,&nbsp;Fiona Rohlffs PhD ,&nbsp;Daour Yousef-al-Sarhan MD ,&nbsp;Tilo Kölbel PhD","doi":"10.1016/j.jvsvi.2024.100096","DOIUrl":"10.1016/j.jvsvi.2024.100096","url":null,"abstract":"<div><h3>Objective</h3><p>Data on false lumen (FL) evolution after endovascular repair for aortic dissection showed discouraging findings in terms of complete FL thrombosis. Persistent flow from collateral arteries and distal entry points may prevent FL exclusion. This review aims to present the current techniques and available evidence on endovascular FL management in patients treated for chronic aortic dissection<strong>.</strong></p></div><div><h3>Methods</h3><p>A review of the English literature was undertaken using the MEDLINE and Embase databases from January 2000 to February 2023. Studies reporting on technical and clinical findings of the available endovascular techniques for FL exclusion were considered eligible. Only descriptive data are presented, and no comparison was attempted.</p></div><div><h3>Results</h3><p>The available techniques dedicated to preventing FL retrograde flow are (1) the “Cork in the Bottle technique,” (2) physician-modified aortic occluders, (3) the Knickerbocker technique, and (4) FL endografts (FLEs; the Candy-Plug technique). The “Cork in the Bottle technique” has been related to a 24-month follow-up positive aortic remodeling rate at 80%. The Knickerbocker technique showed technical success at 94% but with a secondary reintervention rate at 31%. Follow-up imaging confirmed aortic diameter regression in 75% of patients. Physician-modified and custom-made FLEs (the Candy-Plug technique) have been used for FL backflow interruption. Published experience on the use of custom-made generation I to III FLEs showed a 94% technical success rate and an 80% complete FL thrombosis. During the midterm follow-up, positive aortic remodeling was detected in up to 90% of patients.</p></div><div><h3>Conclusions</h3><p>Exclusion of FL’s backflow is mandatory in patients managed for chronic aortic dissections and can be achieved with various techniques. All options are associated with high technical success in experienced hands; however, further advancements and long-term follow-up data are needed.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000448/pdfft?md5=6a5499dd9c38587fada64021d36b29a3&pid=1-s2.0-S2949912724000448-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130257","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":"Adaptive balloon weaning algorithm with automated REBOA facilitates proximal homeostasis during reperfusion in a swine hemorrhagic shock model","authors":"Gloria D. Sanin MD ,&nbsp;Nathan T.P. Patel MD ,&nbsp;Gabriel E. Cambronero MD ,&nbsp;Aravindh S. Ganapathy MD ,&nbsp;Aidan P. Wiley BA ,&nbsp;Magan R. Lane BS ,&nbsp;James W. Patterson MS ,&nbsp;James E. Jordan PhD ,&nbsp;Guillaume L. Hoareau DVM PhD ,&nbsp;Austin Johnson MD PhD ,&nbsp;Elaheh Rahbar PhD ,&nbsp;Lucas P. Neff MD ,&nbsp;Timothy K. Williams MD","doi":"10.1016/j.jvsvi.2023.100035","DOIUrl":"10.1016/j.jvsvi.2023.100035","url":null,"abstract":"<div><h3>Objective</h3><p>Restoration of distal blood flow is critical to successfully salvage patients with resuscitative endovascular balloon occlusion of the aorta (REBOA). Yet, ideal methods for REBOA deflation to restore flow and simultaneously avoid proximal hypotension remain undefined. Adaptive balloon titration algorithms to guide deflation may prevent large hemodynamic fluctuations during weaning. We hypothesize that automated REBOA weaning can both augment proximal hemodynamics and avoid hypotension during attempts to completely deflate the REBOA in a swine model of hemorrhagic shock.</p></div><div><h3>Methods</h3><p>Fifteen swine underwent 30% controlled hemorrhage followed by 30 minutes of zone 1 REBOA to recreate a class III hemorrhage. Next, the REBOA was deflated with an automated syringe running an adaptive algorithm that prioritized proximal mean arterial blood pressure (pMAP) &gt;62.5 mmHg during transfusion of shed blood. Upon post-hoc analysis, animal pMAP responses (hypertensive [HTN] vs normotensive [NORM]) and the discovery of low-volume distal flow (low volume in the HTN group and minimal volume in the NORM group) during the intended complete REBOA phase created two distinct cohorts. The performance of the adaptive weaning algorithm during attempts to completely deflate the REBOA was compared between the groups.</p></div><div><h3>Results</h3><p>The two cohorts (HTN, n = 5 [low volume distally] and NORM, n = 10 [minimal volume distally]) differed in pMAP (<em>P</em> = .001) and distal flow (<em>P</em> = .001) during REBOA. During the wean phase, cohorts were similar in pMAP, time with carotid flow within 90% of baseline, and time above the pMAP threshold of 62.5 mmHg (<em>P</em> = .20, <em>P</em> = .59, and <em>P</em> = .95, respectively) despite the weaning algorithm permitting 14.5 mL/kg more distal aortic flow for the HTN cohort (<em>P</em> = .001).</p></div><div><h3>Conclusion</h3><p>Automated REBOA weaning is feasible and maintains consistent hemodynamics across various physiologic profiles. Automated endovascular devices that can interpret and adapt to a range of hemodynamic physiology will soon facilitate precision resuscitation for patients requiring endovascular aortic occlusion. These findings highlight the need for adaptive control to overcome variability in hemodynamics and differences in resuscitation intensity across clinical contexts.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912723000326/pdfft?md5=1f84946362dafee8ace498e9122a0ca4&pid=1-s2.0-S2949912723000326-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139299442","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":"Evaluation of artificial intelligence-generated layperson's summaries from abstracts of vascular surgical scientific papers","authors":"Walter Dorigo MD ,&nbsp;Elena Giacomelli MD, PhD ,&nbsp;Cristiano Calvagna MD ,&nbsp;Filippo Griselli MD ,&nbsp;Sara Speziali MD ,&nbsp;Aaron Thomas Fargion MD ,&nbsp;Sandro Lepidi MD ,&nbsp;Raffaele Pulli MD ,&nbsp;Mario D'Oria MD","doi":"10.1016/j.jvsvi.2024.100107","DOIUrl":"10.1016/j.jvsvi.2024.100107","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to assess the efficacy of ChatGPT 3.5, an artificial intelligence (AI) language model, in generating readable and accurate layperson's summaries from abstracts of vascular surgery studies.</p></div><div><h3>Methods</h3><p>Abstracts from four leading vascular surgery journals published between October 2023 and December 2023 were used. A ChatGPT prompt for developing layperson's summaries was designed based on established methodology. Readability measures and grade-level assessments were compared between original abstracts and ChatGPT-generated summaries. Two vascular surgeons evaluated a randomized sample of ChatGPT summaries for clarity and correctness. Readability scores of original abstracts were compared with ChatGPT-generated layperson's summaries using a <em>t</em> test. Moreover, a subanalysis based on abstract topics was performed. Cohen's kappa assessed interrater reliability for accuracy and clarity.</p></div><div><h3>Results</h3><p>One-hundred fifty papers were included in the database. Statistically significant differences were observed in readability measures and grade-level assessments between original abstracts and AI-generated summaries, indicating improved readability in the latter (mean Global Readability Score of 36.6 ± 13.8 in the original abstract and of 50.5 ± 11.1 in the AI-generated summary; <em>P</em> &lt; .001). This trend persisted across abstract topics and journals. Although one physician found all summaries correct, the other noted inaccuracies in 32% of cases, with mean rating scores of 4.0 and 4.7, respectively, and no interobserver agreement (k value = −0.1).</p></div><div><h3>Conclusions</h3><p>ChatGPT demonstrates usefulness in producing patient-friendly summaries from scientific abstracts in vascular surgery, although the accuracy and quality of AI-generated summaries warrant further scrutiny.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000552/pdfft?md5=c349c228ace6ceb8b96d2c8ff0925bde&pid=1-s2.0-S2949912724000552-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390629","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":"Current arch branched devices and endovascular techniques sealing within the ascending aorta","authors":"Thomas Michael Aherne MB, MCh, MSc, MD, FRCSI(Vasc) ,&nbsp;Cathal O’Leary MD ,&nbsp;Sean Crawford MD, PhD, FRCSC ,&nbsp;Miranda Witheford MD, PhD, FRCSC ,&nbsp;Jennifer Chung MD, MSc, FRCSC ,&nbsp;Kong Teng Tan MD, FRCS, FRCR, FRCPC ,&nbsp;Thomas Fooks Lindsay MDCM, MSc, FRCSC ,&nbsp;Maral Ouzounian MDCM, PhD, FRCSC","doi":"10.1016/j.jvsvi.2024.100097","DOIUrl":"https://doi.org/10.1016/j.jvsvi.2024.100097","url":null,"abstract":"<div><h3>Objective</h3><p>Endovascular techniques, sealing within the ascending aorta, have broadened the scope of aortic practice and have to come to offer a realistic treatment option for many turned down for open intervention. The objective of this narrative review is to examine contemporary literature evaluating current endovascular devices and techniques sealing within the ascending aorta. current endovascular devices and techniques sealing within the ascending aorta.</p></div><div><h3>Methods</h3><p>Medline through PubMed was systematically search for relevant titles. Studies reporting the outcomes of primary endovascular-based interventions, with a proximal landing zone within the ascending aorta (Ishimaru’s Zone 0), were considered for inclusion. Outcomes were narratively reported.</p></div><div><h3>Results</h3><p>Four multibranched and four single-branch devices were reported to provide an effective deal within Zone 0. Device-specific outcomes, indications for use, and supportive technical features were further outlined.</p></div><div><h3>Conclusion</h3><p>The early reports of devices sealing within the ascending aorta are promising, with excellent rates of technical success. Nonetheless, these interventions are associated with significant morbidity. Further well-designed, comparative analyses are essential to definitively guide further graft development and advancements in endovascular strategy.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294991272400045X/pdfft?md5=73b4ff1390a5f79f13cccce9637040fb&pid=1-s2.0-S294991272400045X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540978","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":"Room for improvement in patient compliance during peripheral vascular interventions","authors":"C.Y. Maximilian Png MD ,&nbsp;Laura T. Boitano MD ,&nbsp;Sunita D. Srivastava MD ,&nbsp;Abhisekh Mohapatra MD ,&nbsp;Junaid Y. Malek MD ,&nbsp;Jordan R. Stern MD ,&nbsp;Matthew J. Eagleton MD ,&nbsp;Anahita Dua MD","doi":"10.1016/j.jvsvi.2024.100059","DOIUrl":"10.1016/j.jvsvi.2024.100059","url":null,"abstract":"<div><h3>Background</h3><p>For patients receiving procedural sedation and analgesia (PSA), patient cooperation is crucial, because patients remain continuously aware of operating room activity and can be asked to perform tasks, such as prolonged breath-holds. This survey aimed to collect information on patient compliance with on-table instructions and its relation to periprocedural outcomes from surgeons nationwide performing peripheral vascular interventions (PVIs) under PSA.</p></div><div><h3>Methods</h3><p>A nine-question online survey was sent to 383 vascular surgeons (including both vascular surgery attendings and trainees) across the United States through REDCap from August 30 to September 21, 2021, with responses closed on October 30, 2021. The survey response was analyzed with descriptive statistics.</p></div><div><h3>Results</h3><p>There were 83 (21.6%) vascular surgeons who responded to the survey, of who, 67 (80.7%) were attending vascular surgeons and 16 (19.3%) were vascular surgery trainees. Forty-one respondents (49.4%) performed 11 to 20 PVI cases under PSA every month, and 31 (41.0%) respondents performed 1 to 10 PVI cases under PSA every month. Forty-one respondents (49.4%) reported that in 1% to 10% of their cases, additional contrast and/or radiation was administered because patient moved on the table or did not cooperate with breath-holds; 25 (30.1%) reported that this occurred in 11% to 20% of their cases, 12 (14.5%) reported that this occurred in 21% to 50% of their cases, and 4 (4.8%) reported that this occurred in &gt;50% of their cases. In such cases, the majority of respondents reported a 1% to 10% increase in contrast volume (59.0%), radiation dosage (62.7%), sedative/analgesia administration (46.3%), and procedural time (54.9%). Of cases being converted to general anesthesia owing to inadequate patient cooperation, 35 (42.2%) respondents reported between 1 and 5 cases per month and 3 (3.6%) respondents reported between 6 and 10 cases per month. Of cases being aborted owing to inadequate patient cooperation, 25 respondents (30.1%) reported between 1 and 5 cases per month, and 1 (1.2%) respondent reported between 6 and 10 cases per month.</p></div><div><h3>Conclusions</h3><p>A significant fraction of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration, and procedural time owing to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000072/pdfft?md5=aac0faa93dfa07efc4fd7d4525a7ffa1&pid=1-s2.0-S2949912724000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828158","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":"Mechanical thrombectomy devices for the management of pulmonary embolism","authors":"Yash K. Pandya MD ,&nbsp;Edith Tzeng MD","doi":"10.1016/j.jvsvi.2024.100053","DOIUrl":"10.1016/j.jvsvi.2024.100053","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study was to review the most commonly used percutaneous mechanical thrombectomy devices for the treatment of pulmonary embolism today.</p></div><div><h3>Methods</h3><p>A thorough search of the existing literature was conducted on commonly used percutaneous mechanical thrombectomy devices, most notably Inari Flowtriever, Penumbra’s Indigo Aspiration, and Alphavac. Reported qualitative and quantitative information was abstracted and descriptively reviewed to ascertain the clinical utility and effectiveness of these devices.</p></div><div><h3>Results</h3><p>Inari Flowtriever is one of the most frequently utilized thrombectomy devices with the most substantive industry-sponsored trial data. Penumbra’s Indigo Aspiration is one of the up-and-coming devices that presents certain caveats in addition to the commonly utilized features of a percutaneous mechanical thrombectomy device, making it a viable alternative. Other newer devices such as Alphavac still lack substantial data, with some other lesser-known devices sporadically used and showing limited, primarily anecdotal evidence.</p></div><div><h3>Conclusions</h3><p>Each device has its positives and negatives. Data are growing on the clinical utility of these devices as their use is becoming more common. However, the long-term durability and overall cost-effectiveness remains to be determined.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000011/pdfft?md5=ac1c9eef2355507825c00eefaab82d17&pid=1-s2.0-S2949912724000011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636119","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":"Endovascular aortic repair for ruptured abdominal aortic aneurysm during the COVID-19 era","authors":"Emily A. Grimsley MD,&nbsp;Haroon M. Janjua MS,&nbsp;Mark Asirwatham MD,&nbsp;Meagan D. Read MD,&nbsp;Paul C. Kuo MD, MS, MBA,&nbsp;Dean J. Arnaoutakis MD,&nbsp;Christopher A. Latz MD, MPH","doi":"10.1016/j.jvsvi.2024.100073","DOIUrl":"https://doi.org/10.1016/j.jvsvi.2024.100073","url":null,"abstract":"<div><h3>Objective</h3><p>The COVID-19 pandemic caused significant stress on health care systems, leading to altered care processes (ie, altered treatment algorithms, supply shortages, and personnel shortages). However, the effect of COVID and subsequent altered care processes on many surgical outcomes has not been characterized. In particular, patient outcomes after endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) have not been well reported. Using COVID prevalence as a surrogate for altered processes of care, our aim is to determine changes in COVID-negative patient outcomes after EVAR for rAAA.</p></div><div><h3>Methods</h3><p>Using the Center for Disease Control COVID-19 data, COVID mortality per 3-month quarter was calculated in Florida. The quarters with the three highest mortality rates and three lowest mortality rates were used to establish COVID-heavy and COVID-light timeframes, respectively. Three quarters of 2019 were used for the pre-COVID timeframe for comparison. The Florida Agency for Health Care Administration database was queried using International Classification of Diseases-10 codes to identify patients diagnosed with rAAA who underwent EVAR during each timeframe. COVID-positive patients were excluded. Primary outcomes were in-hospital mortality, morbidity, and length of stay. Stepwise linear and logistic regression with 10-fold cross-validation determined which factors most impacted primary outcomes. Secondary outcomes included individual complication rates.</p></div><div><h3>Results</h3><p>A total of 316 patients were included. There were no significant differences in surgical volume, demographics, or comorbidities except that more patients had peripheral vascular disease in the COVID-light timeframe compared with the pre-COVID timeframe (<em>P</em> = .01). Mortality, length of stay, and complications were not significantly different per timeframe on univariable analysis. Regression confirmed that timeframe was not significantly associated with any primary outcome.</p></div><div><h3>Conclusions</h3><p>Despite increased stress on the health care system during the COVID-19 pandemic, outcomes after EVAR for rAAA were unchanged in Florida. These results imply that despite periods of COVID-heavy stress on the health care system, patient care was maintained at the pre-COVID standard of care.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000217/pdfft?md5=0151770f95124eb51ed12b6482476b3d&pid=1-s2.0-S2949912724000217-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140902175","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":"Narrative review of chronic total occlusion composition to develop biomimetic models of chronic limb-threatening ischemia to enhance revascularization strategies","authors":"Eimear J. Wallace PhD ,&nbsp;Muireann B. O'Reilly BSc ,&nbsp;Joseph Tannian BSc ,&nbsp;Rachel Beatty PhD ,&nbsp;Brian O'Riordan BEng ,&nbsp;Finbar Dolan PhD ,&nbsp;Niamh Hynes MBBCh, BAO, MRCS, MD, ChM, FRCSI, FEBVS ,&nbsp;Garry P. Duffy PhD ,&nbsp;Ruth E. Levey PhD","doi":"10.1016/j.jvsvi.2024.100147","DOIUrl":"10.1016/j.jvsvi.2024.100147","url":null,"abstract":"<div><h3>Objective</h3><div>Peripheral artery disease (PAD) affects &gt;200 million people worldwide and is a chronic vascular disease characterized by impaired blood flow to the lower limbs. Chronic limb-threatening ischemia (CLTI) is the most advanced form of PAD with chronic pain at rest owing to chronic total occlusions (CTOs) within the arteries of the lower limbs. This review explores the composition of CTOs and revascularization strategies being used to treat CLTI and highlights the importance of biomimetic models to enhance revascularization strategies.</div></div><div><h3>Methods</h3><div>A review of literature on CTOs, revascularization strategies, and biomimetic CTO analogues in PAD and CLTI using PubMed databases was performed in December 2023 through to June 2024. We included studies that evaluated the composition of CTOs and that evaluated safety, efficacy, and mortality in adults undergoing revascularization interventions.</div></div><div><h3>Results</h3><div>Studies in the CLTI literature suggest that CTOs consist of lipid, fibrous, and calcium components, which significantly impede or obstruct blood flow to the affected limbs. Revascularization is the first-line treatment to restore blood flow to the lower limbs, by crossing or bypassing CTOs, thereby preventing amputations or death. However, current revascularization approaches are often ineffective when attempting to cross large, complex, multimaterial CTOs and require significant improvement.</div></div><div><h3>Conclusions</h3><div>To do this, a comprehensive understanding of peripheral CTO composition and positioning is required. From this, realistic arterial models containing biomimetic lipid, fibrotic and calcific CTO analogues can be created to aid in the creation and development of devices capable of successfully crossing CTOs to improve revascularization outcomes.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143161127","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":"Approaches and considerations for optimal vessel sizing in peripheral vascular interventions","authors":"Kajol Shah BS ,&nbsp;Judit Csore MD ,&nbsp;Trisha L. Roy BASc, MD, PhD, FRCSC, FACS","doi":"10.1016/j.jvsvi.2024.100092","DOIUrl":"10.1016/j.jvsvi.2024.100092","url":null,"abstract":"<div><h3>Background</h3><p>Vessel sizing has played a pivotal role in guiding balloon and stent selection for coronary interventions, thereby decreasing dissections, vessel stress, and rates of restenosis. Despite its proven benefits in the coronaries, its application in peripheral vascular interventions has remained relatively underexplored.</p></div><div><h3>Methods</h3><p>This review aims to identify invasive and noninvasive imaging modalities available for sizing peripheral vessels as well as elucidate how vessel sizing is affected by measurement techniques, observer variability, and vessel characteristics.</p></div><div><h3>Results</h3><p>Traditionally, digital subtraction angiography (DSA) has been the gold standard for guiding vascular interventions. However, emerging techniques such as intravascular ultrasound (IVUS) examination and optical coherence tomography offer alternative approaches to vessel sizing, including assessment of cross-sectional area and minimal effective diameter.</p></div><div><h3>Results</h3><p>IVUS examination has demonstrated larger vessel diameter measurements and less intraobserver and interobserver variability than DSA. Whereas direct comparisons between IVUS examination and optical coherence tomography in the peripheries has been limited, noninvasive modalities such as computed tomography angiography and magnetic resonance angiography (MRA) provide a three-dimensional approach on vessel sizing, yet their integration into procedural planning remains constrained. Initial studies suggest discrepancies between vessel sizing using CTA and magnetic resonance angiography, warranting further investigation. Moreover, vessel characteristics such as localization and degree of calcification have been shown to influence balloon and stent sizing, highlighting the need for tailored approaches in peripheral vascular intervention.</p></div><div><h3>Conclusions</h3><p>Overall, although disparities exist between DSA and invasive/noninvasive imaging modalities in peripheral vessel sizing, the long-term implications of these differences on procedural outcomes remain poorly understood. Preliminary evidence suggests an opportunity to enhance procedural success, mitigate restenosis rates, and enhance patient care through improved vessel sizing techniques.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000400/pdfft?md5=29f44405ec127f989214a9aa39eff5fe&pid=1-s2.0-S2949912724000400-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050447","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}