Annals of vascular surgery最新文献

{"title":"Evaluation of the Learning Experience after Ultrasound-Guided Percutaneous Arteriovenous Fistula Placement Workshop Utilizing the Ellipsys® Vascular Access System.","authors":"Viktoria Peters, Sebastian Zerwes, Hagen Kerndl, Alexander Hyhlik-Dürr, Dominik Liebetrau","doi":"10.1016/j.avsg.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.01.023","url":null,"abstract":"<p><strong>Objectives: </strong>Excellent ultrasound skills are crucial for planning and creating a percutaneous arteriovenous fistula (AVF). This study presents the findings of a workshop focused on training healthcare professionals in ultrasound-guided puncture techniques for percutaneous AVF placement using the Ellipsys® vascular access system (Medtronic, Minneapolis, MN, USA). Emphasizing the importance of ultrasound guidance in enhancing accuracy and safety, the workshop aimed to equip participants with the necessary skills to perform this procedure effectively.</p><p><strong>Methods: </strong>The workshop consisted of didactic lectures, hands-on training sessions, and case-based discussions. Before and immediately after the workshop, the participants completed a paired, anonymous pre- and post-workshop written survey. The workshop was conducted over a one-day period four times over 13 months at a conference center in Bavaria, Germany. Twenty-one healthcare professionals (18 Male and 3 female) from 14 tertiary and 7 secondary hospitals attended the workshop. Participants included vascular surgeons, nephrologists and interventional radiologists.</p><p><strong>Results: </strong>Participants significantly enhanced their knowledge about percutaneous endovascular arteriovenous fistula creation, with average knowledge scores increasing from 4.24 pre- to 2.33 postworkshop (p=0.02). Participants demonstrated significant improvement in confidence of measuring vessels (1.71 to 1.38, p=0.01). Further improvements reported were in ultrasound knowledge (2,10 to 1,90), confidence in identifying arteries (1,29 to 1,24) and veins (1,33 to 1,19), as well as confidence in depicting vessels in both transverse (1,29 to 1,10) and longitudinal (1,43 to 1,24) projections. These changes were not statistically significant. Feedback surveys indicated a high level of satisfaction with the educational content and hands-on training sessions, with scores for various aspects such as the achievement of personal learning goals (1.08), informativeness of teaching materials (1.09), and overall recommendation of the training (1.0).</p><p><strong>Conclusions: </strong>The workshop provided participants with valuable hands-on experience and demonstrated significant improvement in their knowledge about ultrasound-guided AVF creation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 10-Year Retrospective Comparison of Endovascular and Open Aneurysm Repair for Infective Native Abdominal Aortic Aneurysm","authors":"Khamin Chinsakchai ,&nbsp;Premakorn Khunprasert ,&nbsp;Chanean Ruangsetakit ,&nbsp;Chumpol Wongwanit ,&nbsp;Kiattisak Hongku ,&nbsp;Sasima Tongsai ,&nbsp;Nuttawut Sermsathanasawadi ,&nbsp;Suteekhanit Hahtapornsawan ,&nbsp;Nattawut Puangpunngam ,&nbsp;Tossapol Prapassaro ,&nbsp;Kanin Pruekprasert","doi":"10.1016/j.avsg.2024.10.010","DOIUrl":"10.1016/j.avsg.2024.10.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;This study compared outcomes of endovascular (EVAR) and open aneurysm repair (OAR) in patients with infective native abdominal aortic aneurysms (INAAAs), evaluating perioperative and in-hospital mortality, antibiotic treatment duration, complications, overall survival rates, and reintervention-free times at 10 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective cohort study of 125 INAAA patients (80 EVAR, 45 OAR) diagnosed between January 2004 and December 2019 was conducted. Patients were categorized as fit or unfit for open surgery based on cardiac, respiratory, and renal status, following the guidelines established in the EVAR-1 and EVAR-2 trials. Primary outcomes included 30-day and in-hospital mortality. Secondary outcomes encompassed early and late complications requiring reintervention, antibiotic treatment duration, 10-year overall survival, 10-year reintervention-free survival, and factors influencing 30-day mortality. Statistical analysis used chi-square, t-tests, and Mann-Whitney U tests. Logistic regression assessed mortality. Kaplan-Meier estimation evaluated survival. Analyses used SPSS version 18.0 (&lt;em&gt;P&lt;/em&gt; &lt; 0.05 considered significant)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Males predominated in both OAR (37 of 45, 82.2%) and EVAR (62 of 80, 77.5%) groups (&lt;em&gt;P&lt;/em&gt; = 0.693). Mean age was 64.8 ± 9.8 years for OAR and 69.0 ± 12.6 years for EVAR (&lt;em&gt;P&lt;/em&gt; = 0.063). The abdominal aorta was the most common aneurysm location, accounting for 91 of 125 (72.8%) cases. Salmonella spp. accounted for 19 of 45 (42.2%) of positive culture cases, and 34 of 125 (27.2%) patients had ruptured aneurysms. The EVAR group had a higher proportion of unfit patients (41 of 80, 51.2%) compared to OAR (10 of 45,22.2%; &lt;em&gt;P&lt;/em&gt; = 0.003). Thirty-day mortality rates were 6 of 80 (7.5%) for EVAR and 2 of 45 (4.4%) for OAR; odds ratio (OR) = 1.75 (95% confidence interval (CI): 0.34–9.06), &lt;em&gt;P&lt;/em&gt; = 0.508, while in-hospital mortality rates were 7 of 80 (8.8%) and 5 of 45 (11.1%); OR = 0.77 (95% CI: 0.23–2.58), &lt;em&gt;P&lt;/em&gt; = 0.668. No significant differences were found in antibiotic treatment duration (median 11 vs. 6 months, &lt;em&gt;P&lt;/em&gt; = 0.594), 10-year overall survival rates (62.8% vs. 64.8%, &lt;em&gt;P&lt;/em&gt; = 0.90), or reintervention-free time (83.8% vs. 82.2%, &lt;em&gt;P&lt;/em&gt; = 0.922), and aneurysm-related death (84.7% vs. 92.9%, &lt;em&gt;P&lt;/em&gt; = 0.159). Unfit patient status was an independent predictor of 30-day mortality (adjusted OR, 10.654; 95% CI, 1.041–109.030; &lt;em&gt;P&lt;/em&gt; = 0.046).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our study demonstrates that EVAR and OAR provide comparable outcomes in INAAA management, despite EVAR being performed more frequently in unfit patients. The similar early mortality rates, antibiotic treatment durations, and long-term survival between the 2 approaches support EVAR as a viable alternative to OAR. Importantly, our finding that unfit patient status independently predicts perioperative mo","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 131-142"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Coil Embolization for Endoleak Prevention as an Adjunct to Endovascular Repair of Abdominal Aortic Aneurysm or Subsequently for the Repair of Endoleak","authors":"Toshiaki Yagami ,&nbsp;Takashi Otani ,&nbsp;Soichiro Hase ,&nbsp;Atsuko Honda ,&nbsp;Anita Yau ,&nbsp;Tassei Nakagawa","doi":"10.1016/j.avsg.2024.10.027","DOIUrl":"10.1016/j.avsg.2024.10.027","url":null,"abstract":"<div><h3>Objective</h3><div>This study assessed the real-world safety and efficacy of coil embolization during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) for prophylactic endoleak prevention or as a reintervention for endoleak repair, using the Cerenovus family of coils (Cerenovus, Irvine, CA, USA).</div></div><div><h3>Methods</h3><div>This was a multicenter, retrospective cohort study of consecutive patients who underwent embolization of branching arteries during EVAR of an AAA or as a reintervention for endoleak repair, using Cerenovus coils between January 2017 and December 2021 in Japan. The primary outcome was 30-day reintervention-free survival, defined as cardiovascular mortality or any complication requiring reintervention within 30 days post procedure. Secondary outcomes included conversion to open surgical repair, length of hospitalization, and the following outcomes through 30 days and 1-year post procedure: occurrence of endoleak (Type I-V), reintervention, complications not requiring reintervention, aneurysm-related mortality, coil migration, and all-cause mortality.</div></div><div><h3>Results</h3><div>A total of 306 patients (mean age 76.7 ± 7.8; 16.7% [51/306] female) were included in the study. Infrarenal AAA were most common (175/306; 57.2%), and the mean aneurysm size was 52.1 ± 10.9 mm. At 30 days, reintervention-free survival was achieved in 96.4% (295/306) of the patients; 9 (2.9%) patients required reintervention, and 2 (0.7%) died from cardiovascular causes through 30 days. One (1/305; 0.3%) patient underwent conversion to open repair. The mean length of hospitalization was 8.6 ± 7.2 days. Complications not requiring reintervention occurred in 3.9% (12/306) of the patients through 30-days and 12.4% (38/306) through 1-year. Endoleak occurred in 2.9% (9/306) of the patients at 30 days and 9.5% (29/306) at 1 year. Coil migration and aneurysm rupture were not reported for any patient. Aneurysm-related mortalities occurred in 0.0% (0/305) at 30 days and 0.3% (1/303) at 1 year. All-cause mortalities occurred in 0.7% (2/306) at 30 days and 3.3% (10/304) at 1 year.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the use of Cerenovus coils yielded a high rate of 30-day-reintervention–free survival and low rates of type II endoleak occurrence and recurrence at the target vessel through 30 days and 1 year in patients following EVAR of an AAA with coil embolization, either for prophylactic endoleak prevention during EVAR or as a reintervention to repair an endoleak.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 102-109"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Emergency Room to Operating Room: Multidisciplinary Simulation Training in Emergency Laparotomy for Ruptured Abdominal Aortic Aneurysm – Learning Outcomes and Costs","authors":"Marika Ylönen ,&nbsp;Paavo Paajanen ,&nbsp;Tiia Kukkonen ,&nbsp;Paulus Torkki ,&nbsp;Juha Paloneva ,&nbsp;Eerika Rosqvist","doi":"10.1016/j.avsg.2024.11.017","DOIUrl":"10.1016/j.avsg.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Opportunities to practice emergency laparotomy (EL) and open surgical repair (OSR) for a ruptured abdominal aortic aneurysm (rAAA) are limited. While simulation-based training (SBT) is effective in educating healthcare professionals in medical emergencies, SBT specifically in EL and OSR for rAAA is scarce. It takes a team to diagnose a patient with massive abdominal bleeding, such as in rAAA, to organize primary care, and to provide definite treatment without unnecessary delays. This study investigated the effects of multidisciplinary EL simulation training in OSR for rAAA, from the emergency room (ER) to the operating room (OR), on trainees’ learning outcomes and the costs of the training.</div></div><div><h3>Methods</h3><div>A total of 162 healthcare professionals in 21 simulated emergency laparotomy teams participated in a structured 2-hour course consisting of an introductory lecture and a simulation scenario followed by debriefing. Data were collected using a pre-post self-assessment questionnaire and the T-NOTECHS scale. Implementation costs and the cost of education were calculated.</div></div><div><h3>Results</h3><div>Simulation training improved knowledge, skills, and attitudes of both physicians and nurses. Most of the non-technical skills studied were significantly enhanced in both professional groups. The total cost of the simulation training was €29 415, cost per team €1,400 and cost per participant €182.</div></div><div><h3>Conclusions</h3><div>Multidisciplinary EL simulation training in OSR for rAAA from the ER to the OR is effective in improving knowledge, skills, and attitudes, as well as non-technical skills among both physicians and nurses. The overall costs of training seem reasonable given the significant learning outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 341-350"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technique and Long-Term Results of Laparoscopic Aorto-Bi-Femoral Bypass for Juxta-Renal Aortic Occlusion","authors":"Isabelle Javerliat ,&nbsp;Jérémie Jayet ,&nbsp;Raphaël Coscas ,&nbsp;Clara Duran ,&nbsp;Marc Coggia","doi":"10.1016/j.avsg.2024.11.021","DOIUrl":"10.1016/j.avsg.2024.11.021","url":null,"abstract":"<div><h3>Background</h3><div>Describe the technique and the long-term results of total laparoscopic aorto-bifemoral bypass for juxtarenal aortic occlusion (JRAO).</div></div><div><h3>Methods</h3><div>From December 2000 to January 2023, 16 patients with a JRAO (TASC D lesions) underwent total laparoscopic aorto-bifemoral bypass. The patients’ database was prospective and the file analysis was retrospective.</div></div><div><h3>Results</h3><div>Median age was 61 years (33–79). Ten patients had debilitating intermittent claudication, and 6 patients had severe critical ischemia. All patients were operated on through a laparoscopic left retrorenal approach. One conversion to open surgery was performed. Median operative time was 315 min (240–470). Median total aortic clamping time was 97.5 min (53–140). Median suprarenal aortic clamping time was 16 min (4–23). No hospital mortality nor severe systemic complications occurred. We observed variations in renal function during hospitalization and during the follow-up. However, no patients required early or long-term dialysis. Median follow-up was 116 months (1–213). Two patients developed bilateral femoral pseudoaneurysms (43rd and 186th months). No patient developed false aortic aneurysm. An aortobifemoral bypass was occluded on an antiphospholipid syndrome (151st month). Eight patients died during the follow-up.</div></div><div><h3>Conclusions</h3><div>This series shows that total laparoscopic aortic approach of JRAO is feasible and safe in good surgical risk patients. It represents an additional approach of JRAO at the era of complex endovascular procedures.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 402-408"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreaticoduodenal Artery Aneurysm in a Patient with Celiac Artery Atresia","authors":"Randall A. Bloch ,&nbsp;John E. Shaughnessy ,&nbsp;Robert A. Cambria ,&nbsp;Scott G. Prushik ,&nbsp;Katie E. Shean ,&nbsp;Mark F. Conrad","doi":"10.1016/j.avsg.2024.11.004","DOIUrl":"10.1016/j.avsg.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Visceral artery aneurysms have an array of presentations and management strategies. Pancreaticoduodenal artery aneurysms (PDAAs) are rare, potentially lethal, and necessitate treatment. We present the case of a PDAA in a patient with a congenitally hypoplastic celiac artery treated by open surgical reconstruction.</div></div><div><h3>Case Report</h3><div>A 60-year-old female presented with an incidental 2-cm proximal inferior PDAA. Significantly, her celiac trunk was hypoplastic and all flow to the hepatic, gastric, and splenic arteries stemmed from a dilated superior mesenteric artery. The PDAA was located 1 cm from the origin of the pancreaticoduodenal artery at the superior mesenteric artery and was adhered to the fourth portion of the duodenum. Considering her anatomy, open repair with reconstruction of the pancreaticoduodenal artery was pursued via a midline laparotomy, resection of the PDAA, and primary end-to-side pancreaticoduodenal artery to superior mesenteric artery reconstruction. There was an excellent flow into the pancreaticoduodenal artery, gastroduodenal artery, and their emanating branches intraoperatively and on postoperative imaging. The patient progressed well and was discharged home on postoperative day 5. Liver function tests were serially checked and were within normal limits upon discharge.</div></div><div><h3>Conclusions</h3><div>We demonstrate a safe and successful surgical option for patients with PDAA who required preserved gastroduodenal aneurysm flow.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 165-169"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Irisin as a Predictor for Peripheral Arterial Disease: Insights from a Clinical Study","authors":"Yifan Cao ,&nbsp;Tian Wei ,&nbsp;Yonghao Li ,&nbsp;Hongyong Duan","doi":"10.1016/j.avsg.2024.10.017","DOIUrl":"10.1016/j.avsg.2024.10.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The purpose of this study was to investigate the correlation between serum irisin concentration and peripheral arterial disease (PAD), and to establish clinical prediction nomograms for PAD occurrence by comparing and analyzing clinical data from patients with PAD and healthy controls.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A total of 112 patients with PAD and 90 healthy individuals were recruited for the study. Clinical data from both groups were collected and serum irisin concentration was measured using enzyme-linked immunosorbent assay (ELISA). Correlation analysis was conducted. Risk factors for PAD were identified through univariate and multivariate logistic regression. The clinical prediction nomograms were established and validated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 202 patients were enrolled in this study, with an average age of 63.98 ± 10.40 years. Of these, 123 were male (60.9%) and 79 were female (39.1%). Hypertension was present in 104 patients (51.5%), diabetes in 59 patients (29.2%), dyslipidemia in 94 patients (46.5%), and 105 patients (52.0%) were smokers. Among them, 112 patients were assigned to the PAD group, which included 78 males (69.6%) and 34 females (30.4%), with an average age of 67.54 ± 10.31 years. In this group, 62 patients (55.4%) had hypertension, 53 (47.3%) had diabetes, 62 (55.4%) had dyslipidemia, and 78 (69.6%) were smokers. The Rutherford classification of these patients showed that 64 (57.1%) were at stage I, 25 (22.3%) at stage II, 16 (14.3%) at stage III, and 7 (6.3%) at stage IV. Serum irisin concentration in patients with PAD showed a significant positive correlation with serum high-density lipoprotein (HDL) (&lt;em&gt;r&lt;/em&gt; = 0.255) and a significant negative correlation with Rutherford classification (&lt;em&gt;r&lt;/em&gt; = −0.374) and smoking status (&lt;em&gt;r&lt;/em&gt; = −0.263). Univariate and multivariate logistic regression analyses identified irisin, age, diabetes, dyslipidemia, smoking, creatinine (CR), and neutrophil/lymphocyte ratio (NLR) as independent risk factors for the development of PAD (&lt;em&gt;P&lt;/em&gt; &lt; 0.05). Based on these findings, a clinical prediction nomogram was established. Internal validation of the nomogram demonstrated strong discriminatory ability, with an area under the curve (AUC) of 0.942, indicating the model's excellent performance. Calibration curves and decision curve analyses further confirmed the model's robust calibration and clinical applicability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study concluded that serum irisin concentrations were significantly lower in the PAD group compared to the healthy control group, and that serum irisin concentrations in the PAD group were significantly correlated with serum HDL, Rutherford classification, and smoking status. Additionally, Irisin level, age, diabetes, dyslipidemia, smoking, CR, and NLR were identified as independent risk factors for PAD development. The clinical prediction nomogram based on the","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 70-82"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Limb Ischemia in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support: A Ten-Year Single-Center Experience","authors":"Besma Nejim,&nbsp;Rachael Snow,&nbsp;Marvin Chau,&nbsp;Surav Sakya,&nbsp;Maria Castello-Ramirez,&nbsp;Tanya R. Flohr,&nbsp;Christoph Brehm,&nbsp;Faisal Aziz","doi":"10.1016/j.avsg.2024.11.002","DOIUrl":"10.1016/j.avsg.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly utilized as a life-saving modality in patients with cardiopulmonary compromise. Acute limb ischemia (ALI) has been reported when the femoral artery was accessed, and it was associated with higher mortality in patients on extracorporeal membrane oxygenation (ECMO). However, prior studies were limited by small sample size and the lack of long-term follow-up. We aimed to investigate the predictors of ALI in ECMO and the effect of ALI on long-term mortality.</div></div><div><h3>Methods</h3><div>Retrospective institutional chart review was performed. Patients who underwent VA-ECMO (Jan/2008-Jan/2018) were identified. Primary outcomes were ALI and 4-year mortality. Logistic regression analysis was used to investigate the predictors of ALI. Survival analysis methods were used to examine 4-year mortality.</div></div><div><h3>Results</h3><div>A total of 377 patients were included. Vascular complications took place in 149 (39.5%) patients. The majority was ALI (107, 75.4%). Eleven patients had limb loss. ALI patients were younger (mean age: 50.2 ± 15.9 vs. 54.1 ± 15.5; <em>P</em> = 0.03), were more likely to have history of peripheral arterial disease (PAD) (7.6% vs. 3.0%; <em>P</em> = 0.047), were less likely to be on aspirin (40.2% vs. 54.4%; <em>P</em> = 0.013), and were more likely to be on vasopressors (97.1% vs. 88.0%; <em>P</em> = 0.007). Arterial cannula size was not associated with ALI so as the concurrent use of ventricular offloading devices (intra-aortic balloon pump or Impella (Abiomed Inc, Dancers, MA)). The use of distal perfusion catheter (DPC) was not protective against ALI in this cohort. However, DPC was associated with less likelihood to require vascular intervention (20.1% vs. 32.0%; <em>P</em> = 0.009). In adjusted analysis, aspirin use was protective against ALI [adjusted odds ratios (aOR) 95% CI: 0.52(0.30 – 0.90); <em>P</em> = 0.018]. The only predictor of ALI was the use of vasopressors [aOR (95% CI): 6.8 (1.5 – 30.4); <em>P</em> = 0.012]. For those who were successfully decannulated, 4-year survival was 65.1% in patients without ALI versus 46.8% in ALI (<em>P</em> = 0.044). After adjusting for potential risk factors, 4-year mortality hazard was significantly higher in patients with ALI [HR: 1.80(1.04 – 3.12); <em>P</em> = 0.035].</div></div><div><h3>Conclusions</h3><div>Patients requiring ECMO are critically ill. The development of ALI is detrimental to this population. This effect extends beyond the acute period. ALI increased 4-year mortality risk by 80%. The use of DPC did not protect against ALI, but it was associated with less vascular interventions.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 63-69"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Early-Onset Surgical Site Infection After Lower Extremity Bypass Surgery","authors":"Young Kim ,&nbsp;Christina L. Cui ,&nbsp;Jessica L. Seidelman ,&nbsp;Adam P. Johnson ,&nbsp;Dawn M. Coleman ,&nbsp;Kevin W. Southerland","doi":"10.1016/j.avsg.2024.11.011","DOIUrl":"10.1016/j.avsg.2024.11.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Surgical site infections (SSI) are the most common complication following lower extremity bypass (LEB) surgery. SSIs contribute to significant patient morbidity and healthcare expenditure, and accurate detection of SSIs remains an important step in reduction efforts. In this study, we aimed to characterize early-onset SSIs among patients undergoing LEB surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Institutional medical records were retrospectively queried for all LEB operations performed across 3 hospitals from 2018 to 2022. All SSIs within a 90-day postoperative period were included, per CDC definition, and categorized as early- (within 7 days of operation), standard- (8–30 days), or delayed-onset (31–90 days). The Southampton grading scale was used to stratify the severity of infection (grade 2, erythema; grade 3, erythema with serous drainage; grade 4; erythema with purulent drainage; or grade 5, severe wound necrosis). Data were analyzed using univariate tests and logistic regression analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 517 LEB operations were performed over the 5-year study period. Median follow-up period was 18.5 months. Early-, standard-, and delayed-onset SSIs were diagnosed in 2.9% (&lt;em&gt;n&lt;/em&gt; = 15), 15.1% (&lt;em&gt;n&lt;/em&gt; = 78), and 4.6% (&lt;em&gt;n&lt;/em&gt; = 24) of the patients, respectively. Compared with standard- and delayed-onset groups, patients with early-onset SSIs were more frequently nonsmokers (26.7% vs. 3.9% vs. 8.3%, &lt;em&gt;P&lt;/em&gt; = 0.03) and had lower prevalence of comorbidities. Early-onset SSIs most frequently presented as Southampton grade 2 (60.0%) or grade 5 (20.0%) infections, whereas standard- and delayed-onset SSIs were more evenly distributed among grade 2 (30.4%), grade 3 (41.2%), and grade 4 (21.6%) presentations (&lt;em&gt;P&lt;/em&gt; = 0.002). The most commonly isolated organisms among the early-onset SSI group were Gram-negative rods (20.0%). In comparison, polymicrobial infections (19.6%) and Gram-positive cocci (14.7%) were most common among standard- and delayed-onset groups (&lt;em&gt;P&lt;/em&gt; = 0.04). The early-onset SSI group experienced a longer index hospitalization (11 vs. 6 vs. 8 days, &lt;em&gt;P&lt;/em&gt; = 0.02) and lower 30-day readmission rates (13.3% vs. 59.0% vs. 45.8%, &lt;em&gt;P&lt;/em&gt; = 0.005) compared with standard- and delayed-onset groups. On multivariate analysis, active smoking (hazard ratio [HR] 0.15, 95% confidence interval [CI], 0.02–0.98, &lt;em&gt;P&lt;/em&gt; = 0.035), former smoking (HR 0.08, 95% CI, 0.01–0.71, &lt;em&gt;P&lt;/em&gt; = 0.02), coronary artery disease (HR 0.15, 95% CI, 0.03–0.83, &lt;em&gt;P&lt;/em&gt; = 0.03), and hypertension (HR 0.13, 95% CI, 0.03–0.68, &lt;em&gt;P&lt;/em&gt; = 0.02) were associated with a lower risk of early-onset infection, when compared with patients suffering standard- and delayed-onset SSIs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Early-onset SSIs after LEB surgery have a distinct clinical presentation, impact healthier patients, and are associated with more virulent organisms compared w","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 83-91"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of Ultrasound-Guided Percutaneous Versus Open Brachial Artery Access: Results of the Multicenter Prospective ARCHIBAL Study Percutaneous or Open Brachial Artery Access","authors":"Laurence Destrieux","doi":"10.1016/j.avsg.2024.10.015","DOIUrl":"10.1016/j.avsg.2024.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Although brachial access (BA) has become increasingly used in percutaneous endovascular procedures, results from head-to-head comparisons between open brachial access (OBA) and ultrasound-guided percutaneous brachial access (PBA) are limited in the literature. The objective of our multicenter, prospective, noninterventional ARCHIv BrachiAL study was to compare the safety and efficacy of OBA and PBA to perform peripheral arterial interventions.</div></div><div><h3>Methods</h3><div>From July 2019 to January 2021, all patients needing peripheral endovascular procedures with brachial artery access were consecutively included in the study by 15 surgeons in 14 centers. Procedures were done with 4F-8F (French gauge) introducer sheaths. Arterial closure was done by conventional arterial sutures for OBA and compression or vascular closure devices for PBA. The primary endpoint was the rate of access site complications occurring up to 30 days postoperatively. Secondary endpoints were the occurrence of adverse events and the overall rates of clinical success of BA cannulation and technical success.</div></div><div><h3>Results</h3><div>Among the 251 included patients (mean age, 69.9 years; males 70.5%), 122 (48.6%) had an OBA and 129 (51.4%) had a PBA, without significant differences in baseline demographic and clinical characteristics. 38.6% of the patients had the procedure for more than one indication. Clinical success was achieved in all patients and technical success in 244 patients (97.2%). No death, cerebral, cardiac, or embolic complications were reported. Access site complications (primarily hematomas) were significantly (<em>P</em> = 0.02) more frequent in the PBA (8/129; 6.2%) than the OBA group (1/122; 0.8%) or when using introducer sheaths &gt;6F for OBA or vascular closure devices for PBA.</div></div><div><h3>Conclusions</h3><div>Our prospective study confirmed the safety and effectiveness of BA and showed the benefit in terms of safety of OBA versus PBA even when PBA was ultrasound-guided and performed by trained surgeons. It encourages the use of OBA and ultrasound guidance when using PBA. Large and/or randomized studies should be performed to support these results.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 231-240"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}