Vascular and endovascular surgery最新文献

{"title":"Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic Review and Management Algorithm.","authors":"Angus Pegler, Yogeesan Sivakumaran","doi":"10.1177/15385744251387791","DOIUrl":"https://doi.org/10.1177/15385744251387791","url":null,"abstract":"<p><p>BackgroundAortic dissection following endovascular aneurysm repair (EVAR) may be iatrogenic or a de-novo event. This study aims to systematically review all cases of dissection following EVAR to identify complications specific to each scenario and develop a management algorithm depending on the clinical presentation.MethodsA comprehensive literature search of MEDLINE, Embase, and CENTRAL databases was performed for all studies relating to dissection following EVAR or fenestrated/branched EVAR (F/BrEVAR). Data collected included timing (differentiating iatrogenic and de-novo events), entry tear location, endograft involved, complications, management, and subsequent outcomes. Due to limited data availability, descriptive data was collected and outcomes compared depending on dissection type and timing. Risk of bias was assessed using a standardised tool for case reports.Results46 patients in 37 studies were included. Complications included endograft compression (52.2%), endoleak (15.2%), and rupture (13.0%). Compression was less likely in endografts with proximal fixation (41.9%), compared to those without (69.2%). Type A dissection after EVAR required cardiac surgery with a high mortality (20.0%). In Type B dissection, 2 cases were diagnosed intra-operatively during F/BrEVAR, 1 died. 8 were diagnosed <4 weeks post-operatively, all managed medically with no complications or mortality. 31 were diagnosed >4 weeks, with mortality of 25.8% and high rates of endograft compression (58.1%), endoleak (16.1%), and rupture (19.4%).ConclusionAortic dissection following EVAR may cause endograft compression, endoleak, or rupture, with significant mortality. Complications are more frequent following Type A dissection and late Type B dissection. Early Type B dissection may be amenable to medical management.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387791"},"PeriodicalIF":0.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Outcomes of Type A Aortic Dissection Repair in Patients With Obstructive Sleep Apnea: A Population Study of National Inpatient Sample From 2015 to 2020.","authors":"Renxi Li, Deyanira J Prastein, Stephen J Huddleston","doi":"10.1177/15385744251387757","DOIUrl":"https://doi.org/10.1177/15385744251387757","url":null,"abstract":"<p><p>BackgroundObstructive sleep apnea (OSA) is a recognized risk factor for aortic dissection development due to its association with arterial hypertension, negative intrathoracic pressures during respiratory efforts, and further development of aortic false lumen. However, the impact of OSA on the outcomes of type A aortic dissection (TAAD) repair has not been extensively investigated. Therefore, this study aimed to perform a population-based analysis of the impact of OSA on in-hospital outcomes following TAAD repair.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were employed to compare the in-hospital outcomes between patients with and without OSA, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status were adjusted for.ResultsThere were 465 (10.86%) and 3817 (89.14%) patients with and without OSA who underwent TAAD repair. Patients with and without OSA had comparable in-hospital mortality (9.89% vs 15.75%, aOR = 0.744, 95 CI = 0.535-1.035, <i>P</i> = .08). Patients with OSA had a higher risk of diaphragmatic paralysis (0.86% vs 0.21%, aOR = 4.821, 95 CI = 1.405-16.539, <i>P</i> = .01) but lower risks of pericardial complications (12.04% vs 19.02%, aOR = 0.675, 95 CI = 0.501-0.909, <i>P</i> = .01) and cardiogenic shock (11.40% vs 18.21%, aOR = 0.643, 95 CI = 0.472-0.875, <i>P</i> = .01). All other in-hospital outcomes were comparable.ConclusionWhile OSA is a known risk factor for the development of TAAD, it does not appear to significantly affect short-term surgical outcomes. Future research should focus on stratifying OSA by duration and severity and examining the long-term prognosis of these patients.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387757"},"PeriodicalIF":0.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Endovascular Aortic Repair With Carbon Dioxide: A Systematic Review Toward Zero Contrast Use.","authors":"Luca Felici, Vincenzo Vento, Alberto Davì, Luca Montecchiani, Andrea Xodo, Laura Maria Cacioppa, Chiara Floridi, Louis Magnus, Emanuele Gatta, Emiliano Chisci","doi":"10.1177/15385744251387760","DOIUrl":"https://doi.org/10.1177/15385744251387760","url":null,"abstract":"<p><p><b>Background:</b> Endovascular Aneurysm Repair (EVAR) is a proven, safe, and effective treatment; however, its application may be limited by the potential adverse effects of iodinated contrast medium (ICM), which can exacerbate renal function and may be contraindicated in patients with renal insufficiency. <b>Purpose:</b> This review aims to provide an overview of \"zero-iodine contrast EVAR,\" which uses CO₂ exclusively, as a strategy to mitigate the risk of acute kidney injury (AKI) associated with ICM. <b>Research design:</b> A systematic literature review was conducted in PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify EVAR cases performed using carbon dioxide. The Medical Subject Headings (MeSH) terms used were \"endovascular repair AND abdominal aortic aneurysm AND contrast medium\" and \"endovascular repair AND abdominal aortic aneurysm AND carbon dioxide,\" with inclusion criteria limited to articles in English published until December 2024. <b>Results:</b> The literature search yielded 1167 papers. After removing duplicates, titles and abstracts were screened, and 68 papers underwent full-text review. A total of 16 studies were included in the analysis, encompassing 1625 patients. Of these, 837 patients underwent EVAR with ICM, and 788 patients underwent EVAR with CO₂. Of these, 510 patients were treated with EVAR using CO₂ exclusively. <b>Conclusions:</b> Although this method still faces inherent limitations due to the physicochemical characteristics of CO₂, its use, when combined with additional technical precautions, enables the achievement of zero-contrast results in standard EVAR procedures.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387760"},"PeriodicalIF":0.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stent-Graft Malposition Into a False Lumen Causing Occlusion Following Blunt External Iliac Artery Injury: Case Report of a Novel Technique of Endovascular Therapy for Recanalization.","authors":"Ryo Aoki, Akihiro Inoue, Atsuya Hasegawa, Miyuki Kambe, Daisuke Utsunomiya, Zenjiro Sekikawa","doi":"10.1177/15385744251387774","DOIUrl":"https://doi.org/10.1177/15385744251387774","url":null,"abstract":"<p><p>IntroductionBlunt trauma to the external iliac artery (EIA) is rare but potentially fatal. Endovascular stent-graft placement is used to control hemorrhage and restore limb perfusion. However, the safety profile and potential complications associated with stent-graft treatment are not well documented. We report a case of EIA injury following blunt trauma complicated by stent-graft deployment into a false lumen, successfully managed with an endovascular rescue technique.Case ReportAn 88-year-old man sustained blunt pelvic trauma with active extravasation from the left EIA. Initially, a covered stent-graft was deployed, which inadvertently caused arterial occlusion due to placement within a false lumen. A rescue procedure was performed using an endovascular approach, where a guidewire was advanced through the perigraft space and snared to establish a pull-through technique. Over this, a second stent-graft was deployed within the perigraft space, restoring flow through the true lumen. Follow-up computed tomography images confirmed successful recanalization and persistent exclusion of the false lumen.ConclusionThis case highlights the potential for stent-graft misplacement in EIA trauma and the importance of ensuring access to the true lumen. Accessing the perigraft space and placing an additional stent-graft represents a new therapeutic approach to achieve recanalization in similar complex vascular injuries.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387774"},"PeriodicalIF":0.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Ischaemic Episodes Linked to Carotid Plaque Ulceration: A Multidisciplinary Diagnostic and Management Approach.","authors":"Kausik Chatterjee, Alakendu Sekhar, Allam Harfoush, Michael Babawale, Arun Balakrishnan","doi":"10.1177/15385744251387780","DOIUrl":"https://doi.org/10.1177/15385744251387780","url":null,"abstract":"<p><p>BackgroundIdentifying the aetiology of ischemic stroke can be challenging, especially when critical findings are overlooked. Stroke assessment often relies on standardised guidelines, primarily focused on carotid stenosis severity (>50%) as an intervention criterion. However, this approach may neglect high-risk plaque features. This case report highlights the importance of integrating diagnostic findings with clinical presentation to guide management.Case presentationA 68-year-old male presented with sudden-onset transient right arm weakness. Initial imaging, including MRI and CT angiography, revealed a subtle diffusion-weighted imaging (DWI) abnormality in the left hemisphere and moderate carotid atherosclerosis (<50%) that did not meet guideline criteria for endarterectomy. Despite antiplatelet and anticoagulant therapy, the patient experienced multiple recurrent ischemic episodes. Due to the persistence of symptoms, the multidisciplinary team (MDT) recommended advanced vessel wall MRI, which identified intraplaque haemorrhage and plaque ulcerations in the left internal carotid artery-critical findings missed on conventional imaging. This led to a decision to perform carotid endarterectomy. Histology confirmed atheromatous disease with intraplaque haemorrhage. Following surgery, the follow-up scans showed no new infarcts with no clinical recurrence.DiscussionThis case underscores the limitations of relying solely on carotid stenosis degree in stroke management and highlights the importance of identifying high-risk plaque characteristics. Advanced vessel wall imaging proved instrumental in guiding treatment, while MDT collaboration ensured a tailored approach. The findings emphasise the need to prioritise carotid stenosis characteristics over stenosis degree alone when guiding clinical decisions to optimise outcomes in ischemic stroke management.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387780"},"PeriodicalIF":0.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Life's Essential 8 Score and Stroke Risk in American Adults.","authors":"Jiacong Tan, Huaxin Zhu, Yanyang Zeng, Meihua Li","doi":"10.1177/15385744251387784","DOIUrl":"https://doi.org/10.1177/15385744251387784","url":null,"abstract":"<p><p>ObjectiveThe purpose of this study was designed to assess the correlation between Life's Essential 8 (LE8) score and the risk of stroke in American adults using data from subjects of the NHANES.MethodsSubjects' data were obtained from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2020.The ..LE8 score integrates health behaviors as well as health factors. We employed weighted multivariate logistic regression models as well as propensity score matching methods to explore the relationship between these health behaviors, health factors, and LE8 scores and stroke risk. In addition, the restricted cubic spline (RCS) technique was used to examine possible nonlinear associations between these variables and stroke risk.ResultsA total of 31,653 subjects were included in this study, of whom 1187 (3.8%) had stroke. After considering all covariates, the results of weighted logistic regression modeling showed that subjects with intermediate cardiovascular health (CVH) levels had a significantly lower risk of stroke compared to subjects with low CVH levels(OR = 0.5,95%CI:0.41-0.61), while subjects with high CVH levels had a further reduced risk of stroke (OR = 0.29,95%CI:0.16-0.51). After propensity score matching, the results remain consistent with the above.RCS analysis showed a significant nonlinear correlation between LE8 score and stroke risk(<i>P</i> for nonlinear< 0.001). The results of the subgroup analyses were consistent across categories, indicating a significant negative association between LE8 and stroke.ConclusionAmong American adults, LE8 scores are negatively associated with stroke risk, which can be reduced through early screening and customized interventions for those with low CVH.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387784"},"PeriodicalIF":0.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Segment Adventitial Cystic Disease of the Popliteal Artery Requiring Adductor Hiatus Division: A Case Report.","authors":"Hyeonju Kim, Hyung-Kee Kim","doi":"10.1177/15385744251387752","DOIUrl":"https://doi.org/10.1177/15385744251387752","url":null,"abstract":"<p><p>BackgroundAdventitial cystic disease (ACD) of the popliteal artery is a rare cause of intermittent claudication, typically presenting as a focal lesion, with long-segment involvement being even more uncommon.Case SummaryA 53-year-old man presented with progressive left calf claudication for one year, worsening over the last 6 months. Imaging studies, including computed tomography and magnetic resonance imaging, identified a cystic lesion compressing the popliteal artery, with duplex ultrasound estimating its length at 6 cm. However, intraoperative findings revealed the lesion extended over 10 cm into the adductor hiatus. To achieve proximal control, adductor hiatus division was required. The cystic segment was resected, and a great saphenous vein interposition graft was placed. The patient recovered uneventfully with complete symptom resolution.ConclusionThis case highlights the feasibility of a posterior approach with adductor hiatus division for long-segment ACD, emphasizing the importance of thorough preoperative assessment and tailored surgical planning.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387752"},"PeriodicalIF":0.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Success of Stent Placement via Transradial Approach for Aberrant Right Subclavian Artery Stenosis.","authors":"Yuya Kobayashi, Chinami Yuzawa, Yoshiki Hanaoka, Ken-Ichi Kobayashi, Minori Kurashina, Yusaku Shimizu, Atsushi Sato, Yoshiki Sekijima","doi":"10.1177/15385744251387775","DOIUrl":"https://doi.org/10.1177/15385744251387775","url":null,"abstract":"<p><p>PurposeTo describe a case of recurrent cerebral infarction caused by stenosis at the origin of the aberrant right subclavian artery and to discuss the technical advantages of a radial artery approach for stenting.MethodsA right radial artery approach with a balloon guiding catheter was used to perform stenting, under dual antiplatelet therapy. Distal protection was achieved through proximal balloon occlusion, enabling retrograde contrast visualization of the aortic arch and stenotic segment.ResultsSuccessful stent deployment was achieved with easy access, accurate vessel selection, and full visualization of the landing zone. No perioperative complications occurred, and postoperative CTA follow-up confirmed the absence of in-stent restenosis. The patient was transitioned to single antiplatelet therapy after six months.ConclusionThe radial artery approach with balloon-guided protection appears to be a safe and effective option for treating stenosis at the origin of an aberrant right subclavian artery.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251387775"},"PeriodicalIF":0.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Repair of Dual Visceral Artery Aneurysms With Flow-Diverting Stents: A Case Report.","authors":"Murat Canyiğit, Muhammed Said Beşler, Halil Tekdemir","doi":"10.1177/15385744251355243","DOIUrl":"10.1177/15385744251355243","url":null,"abstract":"<p><p>BackgroundWith the increasing use of diagnostic imaging methods in daily practice, the incidence of visceral artery aneurysms has also risen. VAAs are observed in intra-abdominal regions such as the celiac artery, superior mesenteric artery, inferior mesenteric artery, and renal arteries, with treatment indications and methods varying based on location, size, and symptoms.Case ReportThis clinical report describes the successful endovascular management and short-term follow-up of incidentally detected fusiform aneurysms in the celiac artery and superior mesenteric artery of a 67-year-old male patient using flow-diverting stents.ConclusionThis case highlights the safety, effectiveness, and success of endovascular treatment with flow-diverting stents for fusiform aneurysms involving the celiac artery and superior mesenteric artery.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"774-778"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcarotid Artery Approach for Endovascular Aortic Repair in Treating Complex Descending Thoracic Aortic Pseudoaneurysm With Aortoiliac Occlusion: A Case Report.","authors":"Haofan Shi, Xingyou Guo, Chengkai Su, Haoyue Huang, Yihuan Chen, Jinlong Zhang, Bowen Zhang, Xiang Feng, Zhenya Shen","doi":"10.1177/15385744251339956","DOIUrl":"10.1177/15385744251339956","url":null,"abstract":"<p><p>BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Current diagnostic and treatment guidelines generally advocate for endovascular aortic repair in most cases, with the femoral artery serving as the conventional access route. However, this approach may not be feasible for all patients, particularly those with aortoiliac artery occlusion, necessitating alternative access strategies.Case SummaryThis paper presents a complex case study of a patient with aortoiliac artery occlusion who underwent endovascular aortic repair via the left carotid artery approach for a pseudoaneurysm at the anastomotic site of a descending aortic prosthetic graft. This case underscores the potential value of utilizing the carotid artery as an alternative access route in anatomically challenging situations.ConclusionResearch on transcarotid artery approach endovascular aortic repair is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This case report suggests that endovascular aortic repair via the carotid artery approach may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. While our single case demonstrated successful management with minimal complications, larger studies are needed to fully establish the safety profile and determine if perioperative complications and mortality rates are indeed manageable across diverse patient populations.Clinical ImpactThis study provides valuable insights into the feasibility of the carotid artery as an alternative access route for endovascular aortic repair in patients with aortoiliac artery occlusion. It offers clinicians a potential strategy for cases where the conventional femoral artery route is not feasible. The findings presented herein aim to demonstrate the practicality and relative safety of utilizing the carotid artery for endovascular procedures in anatomically challenging scenarios, contributing to the broader understanding of access alternatives in aortic repair interventions.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"733-741"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}