Vascular and endovascular surgery最新文献

{"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":"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}

{"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":"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":"Use of Branched EVAR in Treatment of Juxtarenal Aortic Aneurysm and Essential Accessory Renal Artery: Another Tool on the Shelf? A Case Report.","authors":"Donatas Opulskis, Imam T P Ritonga, Philipp Franke, Martin J Austermann, Marco Virgilio Usai","doi":"10.1177/15385744241290011","DOIUrl":"10.1177/15385744241290011","url":null,"abstract":"<p><strong>Objective: </strong>We present the case of a 58-year-old male patient referred to our department from a smaller facility for further evaluation and treatment strategy regarding the choice between open or endovascular surgery. The patient was diagnosed with a 6 cm asymptomatic juxtarenal aortic aneurysm and a 5 mm diameter accessory renal artery (ARA) supplying the lower half of left kidney. Further diagnostic assessments indicated that the left ARA was perfusing over 40% of the left kidney.</p><p><strong>Methods: </strong>Given the patient's significant pre-existing medical conditions and elevated perioperative risk, the decision was made to proceed with minimally invasive endovascular surgery using a custom-made 5-branches stent graft (BEVAR).</p><p><strong>Results: </strong>In the early postoperative period, the patient reported left flank pain. A subsequent CT scan identified a partial infarction in the left kidney due to the occlusion of an early small branch from the upper left renal artery. However, laboratory results showed no significant change in renal function compared to preoperative values. The patient was discharged 6 days post-surgery, with no additional complications observed during the early postoperative period.</p><p><strong>Conclusion: </strong>This case report demonstrates that BEVAR is acceptable technique with satisfactory early postoperative outcomes for treating juxtarenal aortic aneurysms with an accessory renal artery in patients who are high-risk candidates for open repair and anatomically unsuitable for FEVAR or Ch-EVAR procedures.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"303-308"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373977","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":"Successful Pedal Bypass in a Patient With Pseudoxanthoma Elasticum.","authors":"Suvi Väärämäki, Olli Hautero, Vesa Rajala, Pasi Nevalainen","doi":"10.1177/15385744241290007","DOIUrl":"10.1177/15385744241290007","url":null,"abstract":"<p><strong>Objectives: </strong>Pseudoxanthoma elasticum (PXE) is a rare metabolic disease, causing calcification in the arterial media layer and further peripheral artery disease (PAD). A high rate of failure has been reported after endovascular and open surgical management of PAD among patients with PXE. Critical limb ischemia (CLI) rarely develops in PXE, and there are only few reports of its treatment.</p><p><strong>Methods: </strong>We present a case report of a 57 year-old female diagnosed with pseudoxanthoma elasticum (PXE). She presented with critical limb ischemia (CLI) and was successfully treated with pedal bypass using the great saphenous vein.</p><p><strong>Results: </strong>Despite obtaining suboptimal outcomes through the initial approach of percutaneous transluminal angioplasty to treat critical limb ischemia, the subsequent bypass operation proved to be a success. At the first follow-up appointment at 1 month, the patient was asymptomatic and the ulceration had almost healed. The patient underwent an ultrasound examination at 3, 6, 12, and 24 months after discharge, and the surveillance was uncomplicated.</p><p><strong>Conclusions: </strong>With a clear indication for surgery, limb-threatening ischemia can be successfully treated with distal bypass, if necessary, in patients with PXE similarly to atherosclerotic PADs. Appropriate diagnostic and surveillance imaging and the utilization of a multidisciplinary team are key components for effective management of PAD in patients with PXE.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"315-319"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484818","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":"Primary Aortic Malignant Peripheral Nerve Sheath Tumor.","authors":"Hisaya Mori, Hisato Takagi","doi":"10.1177/15385744241290014","DOIUrl":"10.1177/15385744241290014","url":null,"abstract":"<p><p>A 74 year-old woman suffering 1 month persisting lumbago was referred with diagnosis of thoracic aortic aneurysm. Blood examinations indicated slightly or moderately elevated noradrenaline, dopamine, and homovanillic acid with normal-range vanillylmandelic acid. Contrast-enhanced CT scans revealed a tumor, protruding both intra- and extra-luminally, in the wall of the distal descending thoracic aorta without any primary focuses in the whole body. Primary aortic sarcoma or periaortic catecholamine-producing paraganglioma infiltrating the aorta was suspected. The tumor with the normal proximal and distal aorta 2-3 cm apart from it was completely resected under femoro-femoral partial cardiopulmonary bypass. Macroscopically, the tumor was originated from the aortic wall and protruded both intra- and extra-luminally. Immunohistochemically, positive S-100 and vimentin; Ki67 levels of 40%; and negative CD34, CK AE1/AE3, and SMA were identified. The aforementioned findings definitively diagnosed primary aortic malignant peripheral nerve sheath tumor, which has been never reported in the literature.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"309-314"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335648","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":"Incidence of Perioperative Outcomes After Carotid Revascularization With Special Emphasis on Myocardial Infarction - A Systematic Review With Meta-Analysis of Randomized Control Trials.","authors":"Panagiota Valaki, Konstantinos G Moulakakis, Spyridon Mylonas, Christos Karathanos, Konstantinos Batzalexis, Athanasios Giannoukas","doi":"10.1177/15385744251330930","DOIUrl":"https://doi.org/10.1177/15385744251330930","url":null,"abstract":"<p><p>Background and AimThe aim of this study is to estimate the incidence of periprocedural outcomes after carotid revascularization with special emphasis on myocardial infarction and assess the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) through systematic review and meta-analysis.MethodsA multiple electronic search was performed in Medline (database provider PubMed), Web of Science Core Collection, EMBASE (database provider Ovid) and Cochrane Central Register of Controlled Trials databases for articles from 2000 up to 2023 reporting outcomes after carotid revascularization. Randomized control trials comparing the perioperative events (30-day results) after CAS and CEA stating the perioperative risk of myocardial infarction were included in the present meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of twelve randomized control trials (RCTs) with 11 153 patients were identified and considered eligible. The pooled risk of periprocedural stroke was found to be reduced after CEA compared to CAS [OR: 1.6, CI 95%:1.3-2.1, <i>P</i> < 0.05], while PMI was found to be more frequent after CEA, favoring CAS [OR: 0.4, CI 95%: 0.2-0.7, <i>P</i> < 0.05]. Periprocedural mortality was lower but not reaching statistical significance in the CEA compared to CAS [OR: 1.1, CI 95%: 0.6-2.1, <i>P</i> = 0.68]. The pooled OR for composite endpoint of stroke, MI or death was in favor of CEA as safer treatment [OR: 1.3, CI 95%: 1-1.5, <i>P</i> < 0.05].ConclusionsPMI risk was lower after CAS, although the currently available data do not demonstrate any increase in mortality rates.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251330930"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744610","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}