Annals of vascular surgery最新文献

{"title":"The Association of Prothrombin Gene G20210A Mutation with Recurrent Venous Thromboembolism: Evidence from a Meta-Analysis.","authors":"Zaiqing Wang, Han Wu","doi":"10.1016/j.avsg.2024.06.044","DOIUrl":"10.1016/j.avsg.2024.06.044","url":null,"abstract":"<p><strong>Objectives: </strong>The prothrombin (PT) G20210A mutation is one of the most prevalent genetic variations associated with an increased susceptibility to the first episode of venous thromboembolism (VTE). However, it remains uncertain whether this inherited thrombophilic abnormality also poses a risk for recurrent VTE. This meta-analysis aimed to assess the relation of PT G20210A mutation to the risk of recurrent VTE.</p><p><strong>Methods: </strong>PubMed and Scopus were systematically searched for pertinent prospective studies. Relative risks (RR) and 95% confidence intervals (CI) were used to test the association. Sixteen studies, with 16,174 participants, were included.</p><p><strong>Results: </strong>Carriers of the G20210 A mutation were at increased risk of recurrent VTE (RR = 1.60, 95% CI = 1.20-2.14) compared to noncarriers; the increased risk was observed in heterozygotes (GA versus GG) (RR = 1.79, 95% CI = 1.24-2.57), but not in GA/AA mutation.</p><p><strong>Conclusions: </strong>This association was found to be significant in the long term (≥5 years of follow-up), but not in the short term (<5 years of follow-up).</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888359","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":"Ascending Aorta Anastomotic Aneurysm Exclusion with Double-Fenestrated PMEG after Open Repair","authors":"","doi":"10.1016/j.avsg.2024.07.093","DOIUrl":"10.1016/j.avsg.2024.07.093","url":null,"abstract":"<div><h3>Background</h3><p>The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.</p></div><div><h3>Methods</h3><p>All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.</p></div><div><h3>Results</h3><p>10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.</p></div><div><h3>Conclusions</h3><p>Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888336","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":"Beyond Conventional: A Systematic Review of Non-Conventional Techniques for Radio-Cephalic Arteriovenous Fistula.","authors":"Muskan Fatima Bhojani, Javeria Malik, Asma Mumtaz, Ziad Sophie, Summaiyya Waseem","doi":"10.1016/j.avsg.2024.07.091","DOIUrl":"10.1016/j.avsg.2024.07.091","url":null,"abstract":"<p><strong>Background: </strong>Radio-cephalic arteriovenous fistulas (RC-AVFs), the preferred vascular access for hemodialysis, have high failure rates. New techniques like the no-touch technique (NTT) and modified no-touch technique (MNTT) have shown promising results. Our objective is to highlight the effectiveness of nonconventional techniques, aiming to address the challenge of arteriovenous fistula (AVF) failure.</p><p><strong>Methods: </strong>We searched Medline, Google Scholar, and Clinicaltrials.gov until April 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five relevant articles were found, all involving human studies on NTT or MNTT for RC-AVF creation. We focused on primary and secondary patency rates, fistula maturation rates, and complications.</p><p><strong>Results: </strong>We reviewed 5 studies as follows: 2 were pilot studies, 2 were prospective studies, and one was retrospective study. Three used NTT, and 2 used MNTT. Among double-arm studies, 3 out of 4 showed a significantly improved primary patency with nonconventional techniques. However, one study found no significant difference between nonconventional and conventional methods (90.5% vs. 84.2%; P = 0.225). In a single-arm study, nonconventional technique (NTT) displayed 54% primary patency at 1 year. Secondary patency rates were in 3 studies. One demonstrated significant secondary patency with nonconventional methods compared to conventional (90% vs. 67.5%; P = 0.028), while another found no significant difference (90.5% vs. 84.2%; P = 0.803). In the single-arm study, the nonconventional technique (NTT) revealed 80% secondary patency at 1 year.</p><p><strong>Conclusions: </strong>Nonconventional techniques (NTT and MNTT) show promise in improving patency rates, hinting at their potential as alternatives to the conventional technique for RC-AVF creation. Further studies are crucial to confirm their effectiveness and evaluate long-term outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888340","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":"Association of Body Surface Area versus Body Mass Index on Outcomes in Peripheral Arterial Disease.","authors":"Qiaoqing Zhong, Rayaan A Yunus, Mahnoor Sohail, Shirin Saeed, Taha A Rehman, Adnan A Khan, Elizabeth Russ, Marc Schermerhorn, Feroze Mahmood, Robina Matyal","doi":"10.1016/j.avsg.2024.07.099","DOIUrl":"10.1016/j.avsg.2024.07.099","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have indicated that increased obesity in patients with established peripheral artery disease (PAD) is inversely associated with disease prognosis, a phenomenon coined as the \"obesity paradox\". A major cause of criticism in studies investigating the obesity paradox is the use of body mass index (BMI) as a surrogate marker in defining and quantifying the degree or severity of obesity. We conducted a retrospective review to verify whether the obesity paradox persists in patients with PAD when using body surface area (BSA) as an alternative anthropometric measure.</p><p><strong>Methods: </strong>Patients undergoing surgery (open or endovascular) for PAD between January 2009 and March 2020 were identified from the Vascular Quality Initiative (VQI) national database. The association between BSA or BMI and risk of postoperative complications was evaluated using logistic regression and restricted cubic spline analysis, both of which were adjusted for demographic and comorbid risk predictors. When analyzing BSA and BMI as categorical variables, patients were grouped according to BSA quintiles and the World Health Organization (WHO) BMI categories.</p><p><strong>Results: </strong>A total of 130,428 patients were included based on our eligibility criteria, of which 85,394 (65.5%) were men. Patients were typically hypertensive (87.8%), diabetic (50.4%), and overweight (63.0% over 25 kg/m²). Patients with a high BMI or BSA typically presented at a younger age and with greater preoperative administration of drugs (statin, angiotensin converting enzyme inhibitor, anticoagulant, and beta blocker). Our results indicate that BSA and BMI are inversely associated with postoperative risk of all-cause morbidity, mortality, and cardiac complications. This finding was displayed when analyzing BMI or BSA as a continuous variable or when indexing patients into BMI or BSA groups.</p><p><strong>Conclusions: </strong>Our data suggests that the obesity paradox persists in patients with PAD when using either BMI or BSA as anthropometric measures. Future studies with a prospective design and utilizing newer anthropometric indices should be conducted to fully verify the presence of this phenomenon.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888338","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 Quantitative Analysis of Publication Trends in Vascular Surgery and a Comparative Analysis with Interventional Radiology.","authors":"Mark Basilious, Michael Mazzucco, Nakia Sarad, Nitin Jethmalani, Christopher Agrusa, Sharif H Ellozy, Brian G DeRubertis, Jordan R Stern, Peter H Connoly","doi":"10.1016/j.avsg.2024.06.042","DOIUrl":"10.1016/j.avsg.2024.06.042","url":null,"abstract":"<p><strong>Background: </strong>Since its recognition as an independent surgical subspecialty, vascular surgery has experienced rapid growth in both surgical volume and research productivity. Trends in vascular surgery research have not been well characterized. Understanding how research in the field has evolved in comparison to interventional radiology can offer insights into evolving interests and discrepancies between the specialties.</p><p><strong>Methods: </strong>Primary and secondary research publications indexed in the MEDLINE database from 1992 to 2023 were analyzed using a novel text mining algorithm. Eight high-impact vascular surgery journals and 6 interventional radiology journals were included. Articles were categorized based on treatment modalities, pathologies, and other subgroup analyses. Temporal trends were assessed using linear regression and correlation analysis. A comparative analysis was performed assessing publication trends by broad pathology groups between vascular surgery and interventional radiology journals. A further subgroup analysis was conducted comparing publication trends by endovascular treatment modality for peripheral arterial disease (PAD).</p><p><strong>Results: </strong>28,931 vascular surgery publications and 13,094 interventional radiology publications met the inclusion criteria. Publication volume grew exponentially, with over 50% emerging in the last decade. Publications exploring endovascular interventions have increasingly exceeded those focused on exclusively open interventions in research volume since 2006. Aortic pathology, carotid disease, PAD, and venous pathology represented the vast majority of vascular surgery research output, with PAD exhibiting the fastest growth. Comparative analysis revealed a number of key differences in research focus and treatment modalities between vascular surgery and interventional radiology, including a greater emphasis on venous pathology in interventional radiology journals and fewer relative publications on carotid artery pathology (P < 0.001). When comparing endovascular treatments for PAD, interventional radiology journals published more frequently on endovascular brachytherapy (8.73% vs 1.02%, P < 0.001) and less frequently on atherectomy (4.29% vs 6.50%, P = 0.035) as compared to the vascular surgery journals.</p><p><strong>Conclusions: </strong>Our findings demonstrate increasing emphasis on endovascular interventions and specific pathologies in vascular surgery research. Despite some key differences, there is notable overlap in interests between vascular surgery and interventional radiology, which may represent promising opportunities for collaboration in advancing endovascular procedures. Differences in research focus may stem from specialty perspectives and be perpetuated by differences in training.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888335","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":"Long-term mortality and morbidity after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis.","authors":"Philippe Tresson, Stéphane Lo, Emeraude Rivoire, Tae-Hee Cho, Antoine Millon, Anne Long","doi":"10.1016/j.avsg.2024.07.085","DOIUrl":"https://doi.org/10.1016/j.avsg.2024.07.085","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether the occurrence of ischemic stroke due to carotid stenosis is a marker of the severity of atherosclerotic disease and of an excess risk of cardiovascular morbidity and mortality, and of all-cause mortality, after carotid endarterectomy.</p><p><strong>Methods: </strong>Patients who had undergone a carotid endarterectomy (CEA) from June 2015 to august 2016 were included. Patients were classified into two groups, namely symptomatic and asymptomatic. Neurological event, myocardial infarction and death during early follow-up were monitored. Major adverse cardiovascular events (MACE), major limb events (MALE), and all-cause mortality were compared for patients with a CEA for an asymptomatic carotid stenosis versus those with a symptomatic stenosis.</p><p><strong>Results: </strong>Among the 190 patients included, 86 (51%) had a CEA for an asymptomatic stenosis and 84 (49%) for a symptomatic stenosis. During the first 30 days, the rate of all-cause death or ischemic stroke was similar in both groups (1%, p=0.986). After 30 days, there were a total of 35 MACE (21.3%) and 15 MALE (9.1%) during mean follow-up of 53 (22.6) months. Overall cardiovascular morbidity and mortality was 30.4%, and did not differ between groups (p=0.565). New ischemic stroke occurred in 11 patients (9.1%) and was significantly more frequent in the asymptomatic group (9 (14.8%) vs 2 (3.6%) in the symptomatic group, (OR: 4.96; CI 95% [1.04-23.77]; p = 0.013)). Overall all-cause mortality was 24% in both groups (p=0.93) CONCLUSION: The occurrence of ischemic stroke of carotid origin prior to revascularization does not appear to be associated with an excess risk of cardiovascular morbidity or mortality or all-cause mortality after surgery.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905652","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":"Impact of Wound Closure Technique on Surgical Site Infection After Lower Extremity Bypass Surgery","authors":"","doi":"10.1016/j.avsg.2024.06.046","DOIUrl":"10.1016/j.avsg.2024.06.046","url":null,"abstract":"<div><h3>Background</h3><p>Surgical site infections (SSIs) are among the most common complications after lower extremity bypass (LEB). Both patient and hospital-related factors have been associated with SSI after LEB; however, the impact of surgical closure technique on SSI incidence remains unclear.</p></div><div><h3>Methods</h3><p>Institutional electronic medical records (EMRs) were retrospectively queried for all LEB procedures performed from 2018 to 2022. Data were collected on patient demographics, medical comorbidities, operative details, wound closure techniques, and postoperative outcomes. Closure techniques included skin staples, absorbable monofilament (<em>Monocryl</em>), nonabsorbable monofilament (<em>Nylon</em>), or left open to heal by secondary intention. Logistic regression analysis was utilized to identify risk factors and calculate adjusted odds ratios (ORs) for postoperative SSI.</p></div><div><h3>Results</h3><p>A total of 517 patients underwent LEB surgery over the study period. SSI was diagnosed in 120 (23.2%) patients over a median follow-up period of 1.5 years. The most common SSI locations were groin incision (40.0%), saphenectomy (31.7%), and leg incision (19.2%). The median onset of SSI was 18.5 d (interquartile range [IQR] 11–28 d) post-LEB surgery. Patients with SSI had higher body mass index (BMI) (28.2 [IQR 24.2–33.5] vs. 26.6 [23.1–31.5] kg/m², <em>P</em> = 0.03) compared with non-SSI patients. Patient age, sex, and medical comorbidities were otherwise similar between groups. There were no differences in closure technique (79.2% vs. 78.1% staples, 18.3% vs. 19.7% <em>Monocryl</em>, 0.8% vs. 1.8% <em>Nylon</em>, 1.7% vs. 0.5% open; <em>P</em> = 0.53) in SSI versus non-SSI groups. On multivariate analysis, patient BMI (OR 1.04 per unit, 95% confidence interval [CI] 1.01–1.08, <em>P</em> = 0.02), reoperative field (OR 1.81, 95% CI 1.00–3.25, <em>P</em> = 0.03), and active smoking (OR 2.72, 95% CI 1.12–6.59, <em>P</em> = 0.048) were independently associated with increased SSI incidence. Postoperative SSI resulted in prolonged hospital length of stay (LOS) (7 vs. 6 days, <em>P</em> = 0.04), unplanned hospital readmission (49.2% vs. 12.3%, <em>P</em> &lt; 0.001), and reoperation rates (64.7% vs. 8.1%, <em>P</em> &lt; 0.001). Bypass graft infection rates were also higher among patients suffering postoperative SSI (9.2% vs. 0.0%, <em>P</em> &lt; 0.001). On subset analysis of patients at increased risk of postoperative SSI, as found on multivariate modeling, there were no differences in closure technique between SSI and no SSI groups.</p></div><div><h3>Conclusions</h3><p>This study provides insights on wound closure techniques and postoperative SSI made available through granular, operative data that are not found in large database analyses. Surgical wound closure technique was not associated with postoperative SSI after LEB surgery, even among patients at increased risk of infection. These data support individua","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888353","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":"Beta Blockers are Associated with Increased Mortality Without a Decrease in Reinterventions After Endovascular Abdominal Aortic Repair (EVAR).","authors":"Raquel Vicario-Feliciano, Ahsan Zil-E-Ali, Faisal Aziz","doi":"10.1016/j.avsg.2024.07.104","DOIUrl":"10.1016/j.avsg.2024.07.104","url":null,"abstract":"<p><strong>Introduction: </strong>Predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and the impact of sac behavior on long-term survival are not well known. There are limited multicenter trials studying the impact of beta blockers (BBs) on sac behavior. BBs have consistently failed to show a benefit on abdominal aortic aneurysm sac regression in patients with connective tissue disorders and the general population. This study aims to assess the association between BBs and sac behavior after EVAR.</p><p><strong>Methods: </strong>Patients undergoing EVAR registered in Vascular Quality Initiative (2003-2021) stratified by BB and no BB on discharged after an index procedure were assessed at follow-up of 30 days and 1 year. The primary outcomes included mortality and reintervention at 30 days and 1 year. The causes of reintervention were also studied at the defined time endpoints. Categorical and continuous variables were analyzed separately for association between the 2 groups. A P value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 50,411 patients, stratified by BB (28,866; 57.3%), and no BB (21,545; 42.7%) were studied. Patients with hypertension, diabetes, chronic obstructive pulmonary disease, coronary artery disease, prior history of coronary artery bypass graft or percutaneous coronary intervention, prior angioplasty or stent, lower extremity bypass, carotid surgery, major amputation, and smokers were more likely to be on a BB at the time of discharge (P < 0.05). There was no significant difference in reinterventions when comparing patients with and without BB (P = 0.061). At 30-day follow-up, there was no significant difference between the 2 groups for any cause of reintervention. At 1-year follow-up, patients on BB were less likely to need reintervention for graft occlusion (no BB 18.70%, BB 11.77%, P = 0.002). There was no significant difference in reintervention for all other causes at 1-year follow-up. There was an increase in 30-day (no BB 0.20%, BB 0.33%, P = 0.007) and 1-year mortality (no BB 2.35%, BB 3.19%, P < 0.001) in patients on BBs. A time to event adjusted analysis based on Cox proportional hazard model revealed a 26% higher risk of 1-year mortality for patients on BB (hazard ratio: 1.26 [1.10-1.41] P < 0.001).</p><p><strong>Conclusions: </strong>Despite theoretical benefits of BBs on aneurysm behavior, review of the largest national vascular surgery database shows that patients on BBs do not have lower incidence of endovascular reinterventions after EVAR while additionally showing a higher mortality in this patient population.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892638","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":"Ascending Geometry After Thoracic Endovascular Aortic Repair for Descending Aortic Dissection","authors":"","doi":"10.1016/j.avsg.2024.07.100","DOIUrl":"10.1016/j.avsg.2024.07.100","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to assess geometry changes of the ascending aorta after thoracic endovascular aortic repair (TEVAR) for descending aortic dissection and identify potential risk factors for diameter and length change.</p></div><div><h3>Methods</h3><p>Between April 2009 and July 2021, 102 patients were treated for acute descending aortic dissections (type B and non-A non-B) with TEVAR and were included in this analysis. Computed tomography angiographic scans were transferred to a dedicated imaging software and detailed aortic measurements (including length, diameter and area) were taken in multiplanar reconstruction postoperatively, after 6 months and annually thereafter.</p></div><div><h3>Results</h3><p>Sixty-five (58%) patients were male, with a mean age of 66 (±11). Four (4%) patients were diagnosed with connective tissue disease. Before TEVAR, 79% of our patients were treated with a mean of 1.5 (±1.2) different classes of antihypertensive medications. This number rose to 98% after TEVAR and 2.7 (±1.0) different antihypertensive drugs. There was no significant change in length, diameter, cross-sectional area, or volume of the ascending aorta during the follow-up of 3 years after TEVAR. Body height was a negative predictor for mean ascending aortic diameter (<em>P</em> value = −0.013; B = −8.890) and mean aortic diameter at the level of the brachiocephalic trunk (<em>P</em> value = 0.039; B = −14.763).</p></div><div><h3>Conclusions</h3><p>Our data suggest no significant changes in the ascending aorta following TEVAR of the descending thoracic aorta during mid-term follow-up when under stringent blood pressure medication. Additionally, we did not find any modifiable risk factors for geometry parameter increase.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0890509624004977/pdfft?md5=eda66e58adfcc64e1b7558b780cb5452&pid=1-s2.0-S0890509624004977-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888337","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":"Expansion of WallStents® after Initial Deployment in Nonthrombotic Iliac Vein Lesions.","authors":"Nisha D S Gill-Jones, Justin M Robbins, Srinanda Gadula, Amrit Hingorani, Hoang Nguyen, Yuriy Ostrozhynskyy, Afsha Aurshina, Natalie Marks, Enrico Ascher, Anil Hingorani","doi":"10.1016/j.avsg.2024.07.097","DOIUrl":"10.1016/j.avsg.2024.07.097","url":null,"abstract":"<p><strong>Background: </strong>To determine the structural changes of Wallstents (Boston Scientific, Natick, MA) in vivo following deployment in iliac veins.</p><p><strong>Methods: </strong>This retrospective single-center study was performed from September 2012 to April 2013 and included 100 office-based patients who underwent initial stent placement for nonthrombotic iliac vein lesions with Wallstent as well as a second procedure for stenting of the contralateral iliac vein. Measurements were obtained with marker balloons and the diameters of the stents were compared at the time of the index procedure to the secondary procedure.</p><p><strong>Results: </strong>The average time between the 2 procedures was 28 days (range 3-237, SD ± 39.89). The overall average stent diameter after the index procedure was 16.38 mm (range 10.95-21.45, SD ± 2.24). The overall average stent diameter of the index stent when remeasured during the second intervention was 17.58 mm (range 12.84-24.11, SD ± 2.38, P = 0.0003), which was significantly different from the initial measurements. There was no difference when comparing changes in stent diameter by gender or laterality of procedure. However, there was a significant difference in expansion of stents when placed in the common iliac vein versus the external iliac or common femoral veins.</p><p><strong>Conclusions: </strong>This study shows that self-expanding Wallstents can continue to expand days to weeks in vivo following initial deployment. Additionally, we found that the change in diameter from initial placement to follow-up was more significant in stents placed in the proximal and middle segments of the common iliac vein.</p><p><strong>Clinical relevance: </strong>Wallstents are durable implants designed to last within a patient for the rest of their life, it is important to understand the structural changes occurring after their placement. This study allows for a better understanding of Wallstent dynamics in vivo.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888352","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}