Annals of vascular surgery最新文献

{"title":"Association of anemia and transfusion with major adverse cardiac events and major adverse limb events in patients undergoing open infrainguinal bypass.","authors":"Michelle Manesh, Alexander DiBartolomeo, Helen Potter, Li Ding, Sukgu M Han, Tze-Woei Tan, Gregory Magee","doi":"10.1016/j.avsg.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.avsg.2024.10.007","url":null,"abstract":"<p><strong>Introduction: </strong>Anemia is highly prevalent patients with peripheral vascular disease and has been associated with postoperative cardiac events and mortality, and adverse limb events after revascularization procedures. Allogenic blood transfusions have also been associated with adverse events including hospital acquired infections, cardiac morbidity and reduced survival. The aim of this study was to evaluate the impact of blood transfusion on major adverse cardiac events (MACE) and major adverse limb events (MALE) in patients undergoing infrainguinal lower extremity bypass operations.</p><p><strong>Methods: </strong>We performed a retrospective cohort analysis of patients undergoing infrainguinal lower extremity bypass in the Society for Vascular Surgery Vascular Quality Initiative database between 2003 and 2020. Patients were first grouped by their preoperative hemoglobin (Hgb) number (severe anemia: Hgb 7-10g/dL; moderate anemia: 10-12g/dL; normal Hgb: >12g/dL) and then stratified by their transfusion status (perioperative transfusion vs. no perioperative transfusion). Primary endpoints were MACE, defined as myocardial infarction, new congestive heart failure, dysrhythmia, or stroke in the postoperative period, and MALE, defined as return to operating room for thrombosis, loss of primary patency on follow-up and major ipsilateral amputation on follow-up. Secondary outcomes included wound complications, graft infections, 30-day mortality and 1-year survival. Outcomes were compared between patients who received transfusions and those who did not at every anemic threshold. Multivariable logistic regression was performed to evaluate the impact of blood transfusion on primary outcomes.</p><p><strong>Results: </strong>A total of 55,884 patients were included for analysis, of which 16.3% had severe anemia, 25.9% had moderate anemia and 57.8% had normal hemoglobin. Anemia severity was associated with increased rates of MACE (9.8% vs. 8.3% vs. 5.2%, p<0.0001) and MALE (32.2% vs. 24.8% vs. 18.6%, p<0.0001). On univariate analysis, transfusion was consistently associated with increased rates of MACE and MALE at every anemic threshold (p<0.0001 for all). Transfusion was also associated with increased rates of 30-day mortality at all anemic thresholds (p<0.0001 for all) and reduced 1-year survival at all anemic thresholds (log-rank p<0.0001 for all). On multivariable analysis for MACE, an interaction factor was observed between preoperative Hgb and transfusion status (p<0.0001). At every anemic threshold, transfusion was independently associated with MACE (severe: OR 2.4 [95% CI: 2.0 - 2.9]; moderate: OR 2.8 [95% CI: 2.5 - 3.2]; normal: OR 4.5 [95% CI: 4.0 - 5.0]). On multivariable analysis for MALE, an interaction factor was also observed between preoperative Hgb and transfusion status (p<0.0001). At every anemic threshold, transfusion was independently associated with MALE (severe: OR 2.1 [95% CI: 1.9 - 2.3]; moderate: OR 1.8 [95% CI: 1.7","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493485","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":"Sarcopenia Influences Clinical Outcome in Hospitalized Patients with Peripheral Artery Disease Aged 75 Years and Older.","authors":"Volker H Schmitt, Lukas Hobohm, Christoph Brochhausen, Christine Espinola-Klein, Philipp Lurz, Thomas Münzel, Omar Hahad, Karsten Keller","doi":"10.1016/j.avsg.2024.09.066","DOIUrl":"10.1016/j.avsg.2024.09.066","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia represents a relevant comorbidity in patients with peripheral artery disease (PAD). However, only few studies exist assessing the clinical burden of sarcopenia in PAD.</p><p><strong>Methods: </strong>All hospitalizations of patients aged ≥75 years who were admitted due to PAD within 2005-2020 in Germany were included in the study and stratified for sarcopenia. Temporal trends and the impact of sarcopenia on treatment procedures as well as adverse in-hospital events were investigated.</p><p><strong>Results: </strong>Overall, 1,166,848 hospitalization cases of patients admitted due to PAD (median age 81.0 [78.0-85.0] years; 49.5% female sex) were included, of which 2,109 (0.2%) were coded with sarcopenia. Prevalence of sarcopenia in these patients increased during the observational period from 0.05% in 2005 to 0.34% in 2020 (β 2.61 [95%CI 2.42-2.80], P < 0.001). Sarcopenic PAD patients were more often female (52.1% vs. 49.5%, P = 0.015), obese (6.6% vs. 5.5%, P = 0.021), and revealed higher prevalences of comorbidities (Charlson comorbidity index, 7.00 [6.00-9.00] vs. 6.00 [5.00-7.00], P < 0.001). Sarcopenia was associated with reduced usage of reperfusion treatments (endovascular intervention: odds ratio (OR) 0.409 [95%CI 0.358-0.466], P < 0.001; surgical revascularization: OR 0.705 [95%CI 0.617-0.805], P < 0.001) but higher conduction of amputation (OR 1.365 [95%CI 1.231-1.514], P < 0.001) and higher rates of major adverse cardiovascular and cerebrovascular events (MACCE) (OR 1.313 [95%CI 1.141-1.512], P < 0.001) and in-hospital death (OR 1.229 [95%CI 1.052-1.436], P = 0.009).</p><p><strong>Conclusions: </strong>Sarcopenia is an under-recognized condition in PAD patients of high clinical relevance causing a crucial disease burden. Awareness of the ailment needs to be increased in daily clinical practice to identify sarcopenia and improve the clinical outcome of this vulnerable patient group.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456594","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":"Midterm Morphological Change of Kommerell's Diverticulum after Hybrid Thoracic Endovascular Aortic Repair.","authors":"Satoshi Sakakibara, Kazuo Shimamura, Takayuki Shijo, Koichi Maeda, Kizuku Yamashita, Ryota Matsumoto, Daisuke Yoshioka, Masaki Taira, Shigeru Miyagawa","doi":"10.1016/j.avsg.2024.10.005","DOIUrl":"10.1016/j.avsg.2024.10.005","url":null,"abstract":"<p><strong>Background: </strong>Kommerell's diverticulum (KD) is associated with a high incidence of right-sided aortic arch (RAA). Hybrid thoracic endovascular aortic repair (TEVAR) is an effective and less invasive alternative to open repair. However, the long-term results regarding KD diameter regression or symptom improvement remain inadequately described.</p><p><strong>Methods: </strong>Nine patients underwent TEVAR for KD associated with RAA between January 2016 and September 2023 at our university hospital and affiliated institutions. A hybrid procedure was performed to exclude KD by blocking the proximal blood flow with TEVAR and distal blood flow with embolization of the aberrant subclavian artery. Simultaneously, extra-anatomical bypass surgery was performed to revascularize the covered supraarch vessels.</p><p><strong>Results: </strong>The patients' mean age was 65.2 years, and 6 patients were men. Two patients presented with dysphagia, whereas the rest were asymptomatic. The mean diameter and distance to the opposite aortic wall (OAW) of KD were 32.1 mm and 56.2 mm, respectively. For revascularization of the covered supraarch vessels, 6 and 2 patients underwent total debranching with sternotomy and extra-thoracic bypass (bilateral common carotid artery-axial artery bypass), respectively. The 30-day and in-hospital mortality rates were 0%, with no instances of cerebral infarction or spinal cord ischemia. The mean follow-up period was 3.2 years. The survival and avoidance rates of aortic events were 100% at 1 and 3 years. Follow-up computed tomography scans showed no endoleaks; however, 1 (11.1%) type 2 endoleak from the aberrant left subclavian artery occurred 1 week postoperatively, necessitating additional coiling. Seven patients were followed up for more than 1 year, with 5 experiencing reductions of more than 3 mm in KD diameter, distance to the OAW, or both.</p><p><strong>Conclusions: </strong>Although further follow-up and investigations are needed, TEVAR may be a safe and effective surgical treatment for KD associated with RAA.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456541","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":"The Comorbidity-Polypharmacy Score as a Predictive Tool of Survival and Limb Salvage in Patients Undergoing Lower Limb Revascularization Procedures for Chronic Limb-Threatening Ischemia.","authors":"Edoardo Pasqui, Giulia Casilli, Tommaso Anichini, Eleonora Cerbini, Giuseppe Galzerano, Gianmarco de Donato","doi":"10.1016/j.avsg.2024.09.061","DOIUrl":"10.1016/j.avsg.2024.09.061","url":null,"abstract":"<p><strong>Background: </strong>The comorbidity-polypharmacy score (CPPS) was created to evaluate the clinical burden of comorbidities in geriatric patients. It represents an objective tool to stratify patients' risk in different settings. The study aimed to evaluate CPPS in predicting mortality and amputation in patients undergoing elective revascularization procedures in chronic limb-threatening ischemia (CLTI) patients.</p><p><strong>Methods: </strong>This is a 2-year retrospective single-center study. We included all patients undergoing elective lower-limb revascularization procedures admitted with CLTI diagnosis. Four CPPS groups were defined: mild, moderate, severe, and morbid. The primary early and long-term outcomes were 30-day overall mortality, 30-day amputation rate, and overall survival and limb salvage, respectively.</p><p><strong>Results: </strong>A total of 442 patients were enrolled in the study. Mean age was 76.5 ± 9.9 years, and 61.5% (272/442) were male. CPPS was calculated: 22.6% (100/442) have mild CPPS, 54.3% (240/442) moderate, 21.9% (97/442) severe, and 1.2% (5/442) morbid. Kaplan-Meier curves for overall survival stratified by CPPS grade highlighted a strong statistically significant difference (P < 0.0001) among the 4 CPPS classes. Mild CPPS has a significantly higher limb salvage rate among moderate, severe, and morbid CPPS groups (P < 0.0001). Limb salvage for mild and severe CPPS, at 36 months was 95% vs. 85.1%, respectively. Stepwise multivariable Cox-analysis revealed that mortality was independently associated with dialysis, Rutherford Classification V, age, and CPPS. Male sex, multilevel arterial disease, and hybrid surgical repair were independently associated with amputations.</p><p><strong>Conclusions: </strong>CPPS is a straightforward tool to evaluate the patient's complexity and could be used as an adjuvant tool to stratify early- and long-term outcomes in CLTI patients undergoing elective revascularization procedures.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456597","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":"LASER FENESTRATION FOR COMPLEX AORTIC REPAIR: VERSATILE OPTION IN DIFFICULT ANATOMY, EMERGENCIES AND BAILOUTS.","authors":"Peter F Layman, Jaideep Das Gupta, Andrew Barleben","doi":"10.1016/j.avsg.2024.08.025","DOIUrl":"https://doi.org/10.1016/j.avsg.2024.08.025","url":null,"abstract":"<p><strong>Background: </strong>Branched and fenestrated endovascular aortic repair (b/fEVAR) for thoracoabdominal aortic disease as well as thoracic disease (b/fTEVAR) has been well described. Its utilization has also grown over time with the need for solutions having outpaced technologies available in the United States. As more practitioners utilize these and other complex aortic repairs there is a growing utilization of adjunctive modalities expanding the capabilities of current devices. In-situ fenestration (ISF) has arisen as one of those modalities for both vessel fenestration and endoleak repair. ISF has been described for its role in bailout of thoracic endovascular aortic repair (TEVAR) particularly in fenestration for the left subclavian artery, but has not been well described in b/fEVAR in respect to the visceral vessels with most data limited to case series. We sought to review our single institution experience with this technique.</p><p><strong>Methods: </strong>Single institution retrospective review of ISF during initial b/fEVAR, TEVAR from 2020 to 2022. Laser fenestrations post original b/fEVAR or TEVAR for endoleak repair were also included. Perioperative outcomes were obtained as well as angiographic results and short -term results found on follow up CT scans per SVS guidelines. Detailed operative techniques are discussed.</p><p><strong>Results: </strong>A total of 13 patients were identified with 17 laser fenestrations. 11 ISF were planned preoperatively and 2 were intra-op decisions. The indications for surgery were type B aortic dissection with malperfusion (3), thoracoabdominal aortic aneurysm (TAAA): Non-ruptured (7), Ruptured (1), Type III endoleak post b/EVAR (1) and Type IA endoleak s/p fEVAR (1). Laser fenestration was used in conjunction of 3 TEVAR and 10 (b/fEVAR). The distribution of vessels fenestrated was: 5 left renal artery (LRA), 5 right renal artery (RRA), 4 left subclavian artery (LSCA), 1 superior mesenteric artery (SMA), 1 Celiac. Technical success was achieved in all 17 fenestrations with no 30-day mortalities, no post op dissection or spinal cord ischemia. There were 3 cases of endoleak at the completion of the operation, 1 type II and 1 type IIIc.</p><p><strong>Conclusion: </strong>ISF of aortic stent grafts in b/fEVAR and TEVAR is useful as a bailout in complex aortic repair with high likelihood of technical success and low morbidity.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456537","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":"Inflammatory Status as a Predictor of Perioperative Risk in Patients Undergoing Non-Cardiac Vascular Surgery.","authors":"Syed U Ahmed, Michael Fisher, Mohammed S Ahmed","doi":"10.1016/j.avsg.2024.09.054","DOIUrl":"10.1016/j.avsg.2024.09.054","url":null,"abstract":"<p><strong>Background: </strong>Patients scheduled to undergo vascular surgery represent a significant population at risk of major adverse cardiac events (MACE's) post operation. This is due to a number of inflammatory mechanisms, designed to aid in postsurgical recovery. A number of screening tools have been designed, such as the Eagle risk score or the Goldman and Detsky scores, to aid in identification of at-risk individuals. Recently, inflammatory biomarkers have been suggested as a tool to aid in this assessment. The role of interleukins (ILs), such as IL-1 and IL-6, has particularly been of interest to current research. Our hypothesis aims to test whether there is any benefit to measuring inflammatory biomarkers post operation as a tool to identify individuals at the risk of MACEs.</p><p><strong>Methods: </strong>We identified 75 eligible patients scheduled to undergo vascular surgery (bypass, endovascular aneurysm repair or open abdomnial aortic aneurysm repair, or endarterectomy) and measured 4 inflammatory biomarkers (IL-1, IL-6, intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein [CRP]) pre and postoperatively on days 1-4 to identify correlations and identify differences in individuals who had a MACE versus those that did not. A MACE was defined by a rise in T troponin of 0.06 or greater or electrocardiogram changes agreed upon by 2 clinicians or a stroke.</p><p><strong>Results: </strong>Of the 75 patients, 13 were identified to have a MACE. The result showed that both IL-1 and ICAM show a significantly positive correlation between pre and postoperative levels, with ICAM-1 significantly positive on all 4 days and IL-1 significantly positive on days 1, 3, and 4. When comparing the significant difference in change in inflammatory biomarkers between the MACE group and non-MACE group, a significant difference was only noted in the ICAM biomarker. ICAM was significantly different between the 2 groups on day 1 and day 2 (t test value 0.0455 and 0.0492, respectively) but was nonsignificant on days 3 and 4. All other biomarkers showed no significant difference pre and postop.</p><p><strong>Conclusions: </strong>Overall, it is suggestable that measuring inflammatory biomarkers in vascular surgery patients is a valuable aid to clinicians in potentially identifying at-risk groups and should be used as an adjunct to already existing mechanisms available to the clinician.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456536","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":"Anatomical Study of Abdominal Wall Muscle Innervation to Optimize Retroperitoneal Vascular Approach.","authors":"Abdulrahman Alblowi, Nicla Settembre, Humood Alsadery, Victor Nabokov, Manuela Perez, Sergueï Malikov","doi":"10.1016/j.avsg.2024.09.051","DOIUrl":"10.1016/j.avsg.2024.09.051","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Different surgical approaches are used in aortic surgery. Retroperitoneal approaches can result in abdominal wall weakness and flank bulging. These approaches often require dissection of the anterolateral or anteromedial muscles of the abdominal wall. During dissection, the underlying nerves are at great risk of injury, which induces significant complications in abdominal wall muscles. Few studies have been conducted to minimize the risk of injury to these nerves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aims to describe the trajectory of abdominal muscle motor nerves and their relationship to ribs and other anatomical landmarks. The secondary objective is to optimize surgical approaches by preserving the nerves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We conducted 12 dissections on fresh cadavers. Nerve trajectories, the communication between the intercostal nerves (9&lt;sup&gt;th&lt;/sup&gt;-10&lt;sup&gt;th&lt;/sup&gt;-11&lt;sup&gt;th&lt;/sup&gt;) and the subcostal nerve (12&lt;sup&gt;th&lt;/sup&gt;), and the distance from the nerve to the estimated projection point of intersection with the abdominal midline, umbilicus, and iliac crest were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our dissections identified the 12&lt;sup&gt;th&lt;/sup&gt; subcostal nerve as the largest nerve. The 11&lt;sup&gt;th&lt;/sup&gt; intercostal nerve exhibits more accessory branches than other nerves. Multiple communications and branches were observed between the 10th and 11&lt;sup&gt;th&lt;/sup&gt; intercostal nerves and between the 11&lt;sup&gt;th&lt;/sup&gt; and 12&lt;sup&gt;th&lt;/sup&gt; nerves in the region from the anterior axillary line (AAL) to the mid-clavicular line. The estimated projection point of intersection with the midline was 7.92 ± 1.24 cm supraumbilical for the ninth intercostal nerve, 3.92 ± 1.18 cm supraumbilical for the 10th, 1.08 ± 1.52 cm at the umbilical level for the 11&lt;sup&gt;th&lt;/sup&gt;, and -3.33 ± 0.83 cm infraumbilical for the subcostal nerve. The distance between the iliac crest and the iliohypogastric nerve (IHN) in the lateral jackknife position was 2.54 ± 0.65 cm. The 11&lt;sup&gt;th&lt;/sup&gt; nerve had an angle in relation to the rib between -45° and -10° (average: -24.6°), and the 12&lt;sup&gt;th&lt;/sup&gt; nerve had a similar angle between -30° and 0° (average: -18.3°). For the 11&lt;sup&gt;th&lt;/sup&gt; nerve, the distance was between 0 and 5.5 cm (average: 2.92 cm); for the 12&lt;sup&gt;th&lt;/sup&gt; nerve, it was between 0 and 3.0 cm (average: 1.71 cm).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;To preserve the 11&lt;sup&gt;th&lt;/sup&gt; nerve, the optimal approach is a straight incision starting from the upper edge of the 11&lt;sup&gt;th&lt;/sup&gt; rib toward the midline, 4 cm above the umbilicus; for the 12&lt;sup&gt;th&lt;/sup&gt; nerve, the optimal approach is a straight incision starting from the upper edge of the 12&lt;sup&gt;th&lt;/sup&gt; rib toward the midline, 1 cm below the umbilicus; for the IHN, the optimal approach is an incision close to the iliac crest at a distance &lt;1.5 cm. The estimated projection point of intersection between the nerve directions toward the midline can indicate the an","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456600","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":"Mid-Term Results of Popliteal-Pedal Inframalleolar Vein Bypasses in Chronic Limb-Threatening Ischemia Patients After Previous Failed Tibial Endovascular Recanalization.","authors":"Nicola Troisi, Francesco Stilo, Daniele Adami, Giovanni De Caridi, Nunzio Montelione, Giulia Bertagna, Chiara Barillà, Raffaella Berchiolli, Francesco Spinelli, Filippo Benedetto","doi":"10.1016/j.avsg.2024.10.006","DOIUrl":"10.1016/j.avsg.2024.10.006","url":null,"abstract":"<p><strong>Background: </strong>Inframalleolar bypass still preserves its role in the modern endovascular era. Aim of this study was to evaluate the mid-term outcomes of \"short\" inframalleolar vein bypasses in patients with chronic limb-threatening ischemia (CLTI) after the previously failed tibial endovascular recanalization.</p><p><strong>Methods: </strong>Between January 2015 and December 2021,107 CLTI patients in 3 Italian Departments of Vascular Surgery underwent \"short\" inframalleolar vein bypass after failed tibial endovascular recanalization. Early (30-day) and 3-year outcomes were evaluated in terms of survival, primary patency, primary assisted patency, secondary patency, and amputation-free survival. Univariate analysis of the perioperative factors affecting outcomes were performed by the means of log-rank test. The associations of procedure variables were sought based on a multivariate Cox regression analysis.</p><p><strong>Results: </strong>Distal anastomosis (inframalleolar) was mostly performed on dorsal pedis (64, 59.8%). At 30 days, bypass occlusion was recorded in 5 cases (4.6%). The mean follow-up period was 20.5 ± 17.9 months. The estimated 3-year overall survival was 66.7%. Three-year estimates of primary patency, primary assisted patency, secondary patency, and amputation-free survival were 68.5%, 70.1%, 70.2%, and 76.7%, respectively. Multivariate analysis showed a negative association of insulin treatment with primary patency (HR 4.3, P = 0.04), primary assisted patency (HR 5.1, P = 0.02), and secondary patency (HR 5.1, P = 0.02). The negative association of long-term corticosteroid use was also found with primary patency (HR 7.8, P = 0.005), primary assisted patency (HR 8.7, P = 0.003), secondary patency (HR 8.7, P = 0.003), and amputation-free survival (HR 3.9, P = 0.05).</p><p><strong>Conclusions: </strong>Short\" vein bypasses to the foot arteries in CLTI patients yielded good mid-term overall patency and limb salvage rates after a failed tibial endovascular recanalization. Insulin-dependent diabetes mellitus and long-term corticosteroid use seemed to affect the outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456567","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 Housing Status on Surgical Management and Inpatient Outcomes of Chronic Limb-Threatening Ischemia in the United States.","authors":"Hamza Hanif, Pierce Massie, Mohammed Quazi, Katarina Leyba, Amir H Sohail, Abu Baker Sheikh, Ross M Clark, John Marek, Muhammad A Rana","doi":"10.1016/j.avsg.2024.09.064","DOIUrl":"10.1016/j.avsg.2024.09.064","url":null,"abstract":"<p><strong>Background: </strong>Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease. While previous studies have focused on gender and racial disparities, there is lack of evidence regarding the impact of housing status. The aim of this analysis was to identify disparities in inpatient management and outcomes of CLTI based on housing status.</p><p><strong>Methods: </strong>In this retrospective, descriptive study, we analyzed patients admitted with CLTI who underwent revascularization, as identified by International Classification of Diseases, 10th Revision, Clinical Modification codes, between 2016 and 2021, using the National Inpatient Sample database. The patients were stratified by their housing status and a detailed, propensity-matched analysis was conducted to compare the demographics, comorbidities, mortality rates, types of intervention, resource utilization, and inpatient outcomes.</p><p><strong>Results: </strong>During the study, 2,667,294 patients were admitted with CLTI, and 17% (463,435) underwent revascularization. Among these, 0.4% (1,790) was unhoused. Males were overrepresented in the unhoused group (83.5% vs. 62.5%, P < 0.001). Unhoused patients were more likely to receive endovascular revascularization (adjusted odds ratio [AOR] 1.77, 0.45-0.90, P = 0.003) but less likely to undergo open surgical intervention (AOR 0.64, 0.45-0.90, P = 0.010). They were also more likely to undergo aortoiliac interventions, while housed patients underwent more distal interventions. The mean adjusted length of stay was 4 days longer and inflation-adjusted costs were $8,501 higher for unhoused patients (P < 0.001). Unhoused patients were also more likely to leave against medical advice and be transferred to skilled nursing facilities.</p><p><strong>Conclusions: </strong>This study highlights significant disparities in CLTI management and outcomes between housed and unhoused patients, underscoring the need for targeted interventions to address these inequities.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456533","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":"Clinical Application of n-Butyl-2- Cyanoacrylate (NBCA) in the Transarterial Embolization for Type I/II Endoleak During and After EVAR Surgery.","authors":"Li-Ping Jiang, Qi-Bin Wang, Xu Wang, Hong-Mei Zhang, Luo-Yi Ren","doi":"10.1016/j.avsg.2024.09.060","DOIUrl":"10.1016/j.avsg.2024.09.060","url":null,"abstract":"<p><strong>Background: </strong>Exploring the effectiveness and safety of n-butyl-2-cyanoacrylate (NBCA) in the transarterial embolization for common endoleak during and after endovascular repair of aortic aneurysm (EVAR).</p><p><strong>Methods: </strong>A total of 226 patients with abdominal aortic aneurysm (AAA) were treated with EVAR in 4 years from August 2019 to February 2023, including 46 patients with ruptured aneurysms (rAAA). 37 cases, 28 nonruptured AAA patients and 9 rAAA patients, developed endoleak during EVAR surgery and follow-up period and were then treated with NBCA for transarterial embolization. A follow-up was done for at least 6 months to observe its clinical efficacy and adverse reactions.</p><p><strong>Results: </strong>Among 37 cases of endoleak, there were 8 cases of primary type Ia endoleak and one case of primary right type Ib endoleak in the rAAA group, one case of primary type Ib endoleak, 2 cases of secondary type Ia endoleak, and 25 cases of postoperative type II endoleak in the nonruptured AAA group. Three patients with primary type Ia endoleak were treated with coil-assisted NBCA in the rAAA group, while the remaining 34 patients with type I and type II endoleaks were treated with NBCA alone. All transarterial embolization achieved technical success, and the endoleak disappeared. Postoperative hospitalization observation showed that 3 cases of patients in the rAAA group who experienced primary type Ia endoleak during emergency EVAR surgery died within 4 days after surgery due to hemorrhagic shock and multiple organ failure. Two patients experienced non-AAA-related deaths during the follow-up period.</p><p><strong>Conclusions: </strong>Transarterial embolization with NBCA for the treatment of primary and secondary endoleak is a safe and effective method. It can achieve more dense embolization of the aneurysm sac and more complex endoleaks embolization. And, it showed a low recurrence rate of endoleak and the incidence of perioperative complications after surgery, which is worthy of clinical promotion and application. Even in emergency EVAR combined with primary type I endoleak treatment in rAAA patients, patients can still benefit.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456603","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}