Vascular and endovascular surgery最新文献

{"title":"Clinical Outcomes After Distal Bypass in Patients With Chronic Limb-Threatening Ischemia due to Connective Tissue Disease.","authors":"Taira Kobayashi, Masaki Hamamoto, Takanobu Okazaki, Ryo Okusako, Hironori Shimoda, Misa Hasegawa, Shinya Takahashi","doi":"10.1177/15385744241290012","DOIUrl":"10.1177/15385744241290012","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic limb-threatening ischemia (CLTI) is mostly caused by arteriosclerosis, but is sometimes due to connective tissue disease. However, there is a limited knowledge of clinical outcomes of patients with CLTI with connective tissue disease. The objective of the study was to assess outcomes after distal bypass in these patients using global vascular guidelines.</p><p><strong>Material and methods: </strong>Data from distal bypasses performed for CLTI at a single center from 2014 to 2023 were evaluated retrospectively. Clinical outcomes after distal bypass were compared for patients with CLTI with arteriosclerosis (AS group) and those with connective tissue disease (CD group). The primary endpoints were limb salvage and wound healing.</p><p><strong>Results: </strong>Of the 282 distal bypasses performed for 222 patients with CLTI, 22 were conducted for 21 patients with connective tissue disease (CD group). The connective tissue disease was progressive systemic scleroderma (n = 11 patients), pemphigoid diseases (n = 2), polyarteritis nodosa (n = 2), rheumatoid arthritis (n = 2), and others (n = 4). Compared with the AS group, the CD group included more females (<i>P</i> = .007) and had greater oral steroid use (<i>P</i> < .001) and a higher Global Limb Anatomical Staging System (GLASS) inframalleolar (IM) modifier P2 (<i>P</i> < .001). The mean follow-up period of the whole cohort was 27 ± 22 months with no significant difference between the groups (<i>P</i> = .25), and 22 limbs required major amputation during this period. The 2-year limb salvage rate was significantly lower in the CD group compared to the AS group (75% vs 94%, <i>P</i> = .020). Wound healing was achieved in 220 (78%) limbs, and the 12-month wound healing rate was significantly lower in the CD group (52% vs 86%, <i>P</i> = .006).</p><p><strong>Conclusion: </strong>The low 2-year limb salvage and 12-month wound healing rates in patients with CLTI with connective tissue disease indicate that distal bypass may be challenging in these patients.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"243-249"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373975","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":"Does the Combined Arteritis Damage Score (CARDS) in the Diagnosis of Takayasu Arteritis Predict Prognosis and Need for Biologic Therapy?","authors":"Rabia Deniz, Tevfik Güzelbey, Merve Tanrıkulu, Cemal Bes","doi":"10.1177/15385744241292104","DOIUrl":"10.1177/15385744241292104","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate the prognostic value of the combined arteritis damage score (CARDS) in Takayasu arteritis (TAK) patients to predict the need for biologic treatment at diagnosis and the possible contribution of wall thickness (WT).</p><p><strong>Materials and methods: </strong>Blind evaluation of MRA/CTA at the time of diagnosis was performed by a reader rheumatologist (RR) and an interventional radiologist (RIR). The CARDS damage score for 21 arterial regions was assessed as normal, mild or moderate/severe stenosis, occclusion or aneursym/dilatation. Additionally, WT was scored for all regions as present or absent. A modified CARDS (mCARDS) was calculated as the sum of CARDS and the number of WT areas.</p><p><strong>Results: </strong>According to follow-up treatment, 10 patients with non-biologic treatment (non-BT) (F/M:8/2, median age 37.5 years) and 15 patients with biologic treatment (BT) (F/M:13/2, median age 30 years) were included. Indian Takatasu Arteritis Score (ITAS), CRP, and ESR levels were similar in both groups. CARDS (1.4 (0-7.2) vs 4.5 (.6-19), <i>P</i>: .003), WT (1.5 (0-8) vs 7 (1-21), <i>P</i> < .001), and mCARDS (4 (0-14.2) vs 11.4 (1.6-40), <i>P</i> < .001) scores were significantly higher in the BT group compared to nonBT group. Cohen's kappa coefficient between RR and RIR for WT was .99 with 99.6% aggrement, and CARDS was .98 with 99.6% agreement. The AUC values for CARDS, WT, and mCARDS scores were .748 (.605-.892), .837 (.723-.950), and .847 (.735-.958), respectively, and <i>P</i> value was <.0001.</p><p><strong>Conclusions: </strong>The prediction of prognosis and biologic treatment need at TAK diagnosis using non-invasive angiographic images can improve outcomes and prompt closer follow-up. The combination of CARDS and WT as mCARDS achieved the highest sensitivity and specificity, and all scores appear useful for predicting prognosis.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"250-256"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396535","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":"Drug-Coated Balloon Angioplasty for In-Stent Restenosis in the Vertebral Artery Ostium: Experiences From a Single Center.","authors":"Wendeng Xu, Yi Shen, Ye Wang, Bin Liang, Jian Wu, Xiaofeng Zhang","doi":"10.1177/15385744241292115","DOIUrl":"10.1177/15385744241292115","url":null,"abstract":"<p><p><b>Background and purpose:</b> Stenting appears to be a safe treatment for vertebral artery ostial stenosis (VAOS) with low complication rates and positive long-term effects. However, in-stent restenosis (ISR) after stenting is common. Drug-coated balloons (DCBs) are an effective management strategy for ISR in patients with coronary or carotid disease. In this study, we investigated the feasibility, safety, and effectiveness of DCB-assisted angioplasty for the treatment of ISR after treatment of VAOS. <b>Research Design:</b> The study included patients in the Department of Neurology at Beijing Tsinghua Changgung Hospital who underwent DCB-assisted angioplasty for ISR after previously undergoing stenting for VAOS. We retrospectively analyzed the clinical and functional outcomes in these patients. <b>Results:</b> Fourteen patients were enrolled in the study between January 2018 and April 2022. Five of the patients were female, and the mean age was 69.4 ± 7.5 years. The technical success rate was 100% and the mean operation time was 57.1 ± 29.2 minutes. No perioperative complications were reported. There were no new cases of cerebral infarction or transient ischemic attacks in hospital or during 6 months of follow-up. There were only 2 reports of ISR in the vertebral artery ostium in the 6 months following DCB-assisted angioplasty. The median modified Rankin scale score was 0. <b>Conclusion:</b> DCB-assisted angioplasty may be feasible for treatment of ISR after stenting of the vertebral artery ostium. However, more research is needed to confirm our findings.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"266-270"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484811","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":"Successful Percutaneous Rescue Treatment of Acute Carotid Stent Thrombosis Utilizing a Modified Embolic Protection Device.","authors":"Alessandro Di Giorgio, Alessandro Mazzapicchi, Carla Rochira, Salvatore Azzarelli, Francesco Scardaci, Davide Salvatore Tomasello, Vincenzo Argentino, Francesco Amico","doi":"10.1177/15385744241290006","DOIUrl":"10.1177/15385744241290006","url":null,"abstract":"<p><p>Acute Carotid Stent Thrombosis (ACST) is a rare complication of Carotid Artery Stenting (CAS) with a potentially fatal outcome. We report a case of ACST occurring five minutes after the end of a successful CAS procedure that was promptly treated by carotid stent-in-stent implantation using a new percutaneous strategy based on the creation of a modified embolic protection device. Following the procedure, we did not observe brain lesions suggestive of acute cerebral ischemic events at the CT scan performed at 48 hours, as well as no neurological deficits in the following days.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"320-325"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373976","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":"Simultaneous Endovascular Aortic Repair Expands Transcatheter Aortic Valve Replacement Eligibility to Patients With Hostile Aortic Pathology.","authors":"Jeffrey Lu, Benjamin Zambetti, Joshua Plant, Anuj Gupta, Khanjan Nagarsheth, Shahab Toursavadkohi","doi":"10.1177/15385744241292122","DOIUrl":"10.1177/15385744241292122","url":null,"abstract":"<p><strong>Background: </strong>In recent years, Transcatheter Aortic Valve Replacement (TAVR) has become a primary modality of therapy in moderate-high risk patients with symptomatic aortic stenosis. Although clinicians remain vigilant about screening for both aortic stenosis, many patients still, nevertheless, often present only when they are symptomatic. Unfortunately, when isolated TAVR is performed in the context of hostile aortic pathology, it has been reported that patients suffer from higher rates of complications such as rupture, dissection, or death post-operatively.</p><p><strong>Objectives: </strong>To explore the utility of a simultaneous TAVR and endovascular aortic repair in addressing symptomatic aortic stenosis in challenging patients with hostile aortic pathology.</p><p><strong>Methods: </strong>Retrospective case series within a tertiary care hospital between May 2017 and December 2023.</p><p><strong>Results: </strong>A total of 11 patients underwent simultaneous endovascular aortic repair and TAVR. TAVR was performed first in 9/11 (82%) of the procedures while endovascular aortic repair was performed first in 2/11 procedures (18%). The median age was 84 years old (IQR = 77-86 years old). The median LOS was 3 days (IQR = 2-10 days). The median procedure time was 155 minutes (IQR = 111-202 minutes) and the median contrast amount was 100 CC (IQR = 65-139 CC). 2 patients (18%) experienced post-operative complications. Both of these patients required re-intervention. This cohort of patients did not experience any mortality at 30 days related to pertinent complications or adverse MACE events. All patients were transferred to the PACU and ultimately discharged home.</p><p><strong>Conclusions: </strong>Extending TAVR eligibility to high-risk patients with hostile aortic pathology through the implementation of simultaneous endovascular aortic repair, performed via the same access site, is an effective strategy for management of symptomatic aortic stenosis in the context of extensive cardiovascular co-morbidities.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"257-265"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407372","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":"Large Right Subclavian Artery Aneurysm Presenting in a Young Patient.","authors":"Amber Ahmed-Issap, Mukesh Garg, Richard Warwick, Muhammad Kabeer, Abdel Kader Allouni, Arun Pherwani","doi":"10.1177/15385744241293252","DOIUrl":"10.1177/15385744241293252","url":null,"abstract":"<p><p>Subclavian artery aneurysms are extremely rare, accounting for less than 1% all of peripheral aneurysms. They are often due to atherosclerosis or thoracic outlet syndrome and present at an average age of 47 years. Here, we present an incidental finding of an 18 mm rapidly increasing aneurysm involving the first and second part of the right subclavian artery in a woman in her 20s. To our knowledge, this is the youngest patient presenting with a right subclavian artery aneurysm who underwent surgical resection of the aneurysm with repair using interposition graft and successful re-implantation of the vertebral artery with antegrade flow. This report highlights the multidisciplinary care between vascular, interventional radiology and cardiothoracic teams at our tertiary hospital due to the complex nature of the aneurysm.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"342-346"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484814","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":"Study Protocol for a Focus Group Discussion About the Patients' Perspective on Carotid Endarterectomy.","authors":"M S Marsman, G G Koning, B P W Jansen, M M P J Reijnen, M Habibovic, P W H E Vriens","doi":"10.1177/15385744241286585","DOIUrl":"10.1177/15385744241286585","url":null,"abstract":"<p><strong>Introduction: </strong>The outcomes of carotid surgery are commonly evaluated using parameters such as mortality and stroke. The importance of these parameters is based on doctors' and scientific perspectives. Presently, patient centered health care aims to value the evaluation from patients' perspective, mostly using Patient-Reported Outcomes (PROs). The true significance of outcomes of carotid surgery that matter most to the patients is largely unknown. The aim of this study is to identify and verify the patients' perspective on carotid surgery for patients with a symptomatic and significant carotid stenosis.</p><p><strong>Methods and outcomes: </strong>An exploratory semi-structured focus group discussion will be used, as a quality research method. Three groups consisting of 8 patients (<i>n</i> = 24), who underwent the carotid endarterectomy because of a significant and symptomatic stenosis of the internal carotid artery, will be enrolled. If data saturation is not reached, the sample size will be expanded. An expert medical psychologist will lead the focus group discussions. The interviews will be recorded, transcribed 'verbatim' and analyzed after each session. Items valuable to patients regarding their surgery and recovery will be discussed. This protocol will be published prior to the start of the Focus Group Discussion.</p><p><strong>Discussion: </strong>Patients' perspective on outcomes regarding their carotid surgery will be explored and tried to be identified. The results of the focus group discussions may fuel the ongoing global discussion on improving evidence based and patient reported outcome measures and will help the clinical physician to 'understand' their patients better. Focus group discussions may aid in the purpose of verification of PROs and PROMs.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"237-242"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GPT-4o's Accuracy in Diagnosing Aortic Aneurysms and EVAR Complications.","authors":"Muhammed Said Beşler","doi":"10.1177/15385744241290004","DOIUrl":"10.1177/15385744241290004","url":null,"abstract":"","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"347"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335647","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 Treatment of Complex Aorto-Iliac Atherosclerotic Occlusive Disease With Chimney Covered Endovascular Reconstruction of Aortic Bifurcation.","authors":"May Dvir, Fahad Shuja, Indrani Sen, Carmelina Gurrieri, Thomas Carmody, Tiziano Tallarita","doi":"10.1177/15385744241291083","DOIUrl":"10.1177/15385744241291083","url":null,"abstract":"<p><p>Treatment of atherosclerotic occlusive disease of the infrarenal aorta poses several challenges. Traditionally, open surgery has been the preferred method of treatment in standard risk patients, although, it is burdened by high morbidity and mortality. There are many classifications to establish the patient risk for surgery. Among the most common is the American College of Cardiology (ACC)/American Heart Association (AHA) classification. ACC/AHA high-risk patients benefit from the increase in endovascular technology and skills. The treatment modality of atherosclerotic aortic disease has shifted towards a minimally invasive approach, including kissing stents, covered endovascular reconstruction of the aortic bifurcation (CERAB) and, aorto-uniiliac stent grafts. When there is an involvement of vital branches such as the inferior mesenteric (with concomitant occluded superior mesenteric artery) or the renal arteries, Chimney- CERAB technique has been successfully utilized to overcome this challenge. We present three patients with aortoiliac occlusive disease (AIOD) successfully treated with the chimney- CERAB technique to preserve a large inferior mesenteric artery in the setting of occlusion/near occlusion of the other mesenteric vessels.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"331-337"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484812","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":"Routine Use of Indwelling Urinary Catheters During Endovascular Abdominal Aortic Aneurysm Repair is Not Necessary.","authors":"Avital Simone, Lauren Carmon, Priya Rao, Meghan Cichocki, Karen Yuan, Matthew Blecha, Carlos F Bechara, Michael C Soult","doi":"10.1177/15385744241292109","DOIUrl":"10.1177/15385744241292109","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular infra-renal abdominal aortic aneurysm repair (EVAR) has proven to be an effective, less invasive alternative to open aortic aneurysm repair with decreased 30-day mortality. Historically, urinary drainage catheters were routinely placed preoperatively before EVAR in our institution. A shift to reduced catheter placement has occurred in conjunction with percutaneous EVARs becoming more routine. Urethral catheterization carries risk of infection (UTI), urinary retention and prostatic trauma inducing hematuria. The purpose of this study was to evaluate whether avoidance of urinary catheter placement during EVAR is an effective practice to reduce cost and morbidity.</p><p><strong>Methods: </strong>This was a single-institution, retrospective review of 177 consecutive patients who underwent elective infrarenal EVAR. Ruptured aneurysms and emergent EVAR were excluded. The study end points were postoperative UTI, urinary retention, length of stay, and readmission within 30 days. Univariable analysis was performed for these four outcomes in patients with (N = 92 and without (N = 65) preoperative urinary catheter placement. A more expansive multivariable investigation for risk of urinary retention following EVAR was conducted with binary logistic regression with co-variates including age, sex, femoral cutdown, estimated blood loss (EBL), urinary catheter, congestive heart failure, diabetes, and postoperative urinary retention as co-variates.</p><p><strong>Results: </strong>Patients who had a Urinary catheter placed had an over two fold higher event rate of urinary retention (10.9% vs 4.6%) This urinary retention trend lacked power to reach significance (OR 2.52 (.665-9.55). Placement of urinary catheter also had a strong trend towards increased rate of UTI but lacking power for significance (7.6% vs 3.10%, OR 1.96 (.556-6.57). There was no difference with or without urinary catheter placement regarding 30-day readmission (yes catheter 7.6% vs no catheter 6.2%, <i>P</i> = .725), or length of stay (yes catheter 2.13 days vs no catheter 1.74 days, <i>P</i> = .723). Urinary retention was significantly associated with the development of a UTI with 23% of patients who had retention developing UTI compared with 4.2% of patients without retention developing UTI (adjusted odds ratio = 17.98, <i>P</i> = .019). Increased blood loss (<i>P</i> = .027) was also associated with increased rate of UTI on multivariable analysis.</p><p><strong>Conclusions: </strong>Avoidance of preoperative urinary catheter placement displays a trend towards avoiding urinary retention and UTI. Patients who develop post EVAR urinary retention experience a significantly increased rate of UTI. Selective urinary catheter placement should be used to help reduce urinary-related complications following elective EVAR.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"271-276"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484817","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}