Vascular and endovascular surgery最新文献

{"title":"Midterm Results of the STABILISE Technique in the Treatment of Aortic Dissection.","authors":"John F Eidt, Erin Cha, Stephen Hohmann, Javier Vasquez","doi":"10.1177/15385744241312439","DOIUrl":"https://doi.org/10.1177/15385744241312439","url":null,"abstract":"<p><p><b>Background</b>: Contemporary treatments of acute aortic dissection, including medical, surgical, and endovascular options, are remarkably effective at the management of malperfusion and rupture. Unfortunately, long-term studies indicate that 30%-50% of patients need secondary procedures to treat progressive aneurysmal enlargement of the untreated aorta. The Stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) technique was introduced to improve long-term outcomes. <b>Purpose</b>: This study aims to investigate the results of the STABILISE technique in patients with aortic dissection. <b>Methods</b>: This is a single-center, retrospective review of all patients treated with the STABILISE technique. There were 12 de novo type B aortic dissection (TBAD) and 7 residual TBAD following type A aortic dissection (TAAD) repair. <b>Results</b>: There was disruption of the dissection membrane and relamination in all or part of the bare metal stent segment in 100% of cases. The average percent attainment of a uni-luminal aorta in comparison to the length with persistent false lumen was 91 ± 12%. <b>Conclusion</b>: Midterm results suggest that the STABILISE technique may improve aortic remodeling after endovascular treatment of acute dissection.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241312439"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901379","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":"Sonography-Guided Endovascular Retrieval of Fractured Angiocatheter in Brachial Artery: A Case Report.","authors":"Yen-Yang Chen","doi":"10.1177/15385744241302554","DOIUrl":"https://doi.org/10.1177/15385744241302554","url":null,"abstract":"<p><strong>Background: </strong>The insertion of an angiocatheter into a peripheral artery for continuous hemodynamic monitoring is a widely employed clinical practice. Fracture of a angiocatheter retained in an artery, though infrequent, presents a challenge in clinical management, particularly in critically ill patients. Surgical exploration for retrieval is generally required, as fluoroscopy-guided endovascular methods are precluded due to the radiolucency of catheters.</p><p><strong>Case report: </strong>This case report demonstrates the successful retrieval of a fractured catheter from the brachial artery of an 85-year-old critically ill patient through the utilization of endovascular techniques guided by sonography. Key considerations include selecting an appropriate snare system diameter and ensuring real-time sonographic visualization to prevent displacement of the fractured segment.</p><p><strong>Conclusion: </strong>This case illustrates the feasibility and safety of sonography-guided endovascular retrieval as an alternative to surgical intervention for fractured angiocatheters. The proposed strategy demonstrates its applicability in similar clinical scenarios.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241302554"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684044","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":"Functional Outcomes and Complications of Carotid Tandem Lesions After Mechanical Thrombectomy for Treatment of Large-Vessel Occlusion Stroke.","authors":"Colin Scott, Lena Abdulrahman, Mackenzie Snyder, Lidia Castillo, Jeffrey Lu, Eleanor Dunlap, Khanjan Nagarsheth","doi":"10.1177/15385744241301494","DOIUrl":"https://doi.org/10.1177/15385744241301494","url":null,"abstract":"<p><strong>Background: </strong>Large Vessel Occlusion (LVO) stroke patients with tandem lesions (TLs) have been observed to have worse outcomes when compared to patients with simple isolated intracranial occlusions.</p><p><strong>Objective: </strong>To examine the difference in post-operative functional status at discharge for patients treated with mechanical thrombectomy for an acute LVO stroke based on the presence of a tandem carotid lesion.</p><p><strong>Methods: </strong>This is a retrospective cohort study of 589 patients presenting within the first 24 hours of stroke onset who underwent mechanical thrombectomy. The primary outcome was functional status quantified by modified Rankin Score (mRS) at time of discharge. The secondary outcomes were presence of hemorrhagic conversion, midline shift >5 cm, malignant cerebral edema, reocclusion, Thrombolysis in Cerebral Infarction Scale (TICI), and discharge location.</p><p><strong>Results: </strong>Patients with tandem occlusions and those with isolated intracranial lesions had similar baseline demographics. However, in patients with TLs, there was a significantly higher NIH stroke scale at admission and a longer time to recanalization. Modified Rankin Score prior to admission was similar for both groups, but was significantly higher in patients with TLs at discharge. The secondary outcomes were similar for hemorrhagic conversion, discharge to hospice, and a TICI scale of 0, but were significantly worse for patients with TLs for in-hospital mortality, midline shift >5 mm, and malignant cerebral edema. The presence of a tandem lesion predicted a higher modified Rankin Score at discharge in univariate regression modeling (β = .45; <i>P</i>-value = .006).</p><p><strong>Conclusion: </strong>The two groups were similar in baseline characteristics and cardiovascular risk factors, yet patients with tandem carotid lesions experienced more complications during their hospitalization and had greater functional disability at discharge. Patients with a TL had a longer mean time to recanalization, representing a potential explanation for these differences in outcomes.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241301494"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684040","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 of Frailty Index and Postoperative Outcomes of Open Bypass Lower Extremity Revascularization for Acute Limb Ischemia Using the Vascular Quality Initiative.","authors":"Miguel Gonzalez, Maria Paz, Trissa Babrowski","doi":"10.1177/15385744241301178","DOIUrl":"https://doi.org/10.1177/15385744241301178","url":null,"abstract":"<p><strong>Background: </strong>Frailty in patients undergoing surgery is strongly associated with postoperative complications. The risk analysis index (RAI) is a validated model for frailty that has been shown to predict short and long-term outcomes. Through utilization of the Vascular Quality Initiative (VQI), this study examined the application of the VQI-derived RAI in acute limb ischemia (ALI) patients undergoing open bypass lower extremity revascularization.</p><p><strong>Methods: </strong>This is a longitudinal retrospective cohort study conducted on patients undergoing revascularization for ALI from the VQI. Using preoperative variables, an RAI score was calculated for each patient, and they were stratified into six cohorts: ≤20, 21-25, 26-30, 31-35, 35-40, and ≥41. A binary forward multivariate logistic regression was used to determine the risk in each cohort on postoperative outcomes (mortality, amputation, surgical site infection, bypass revision, and discharge destination).</p><p><strong>Results: </strong>The VQI dataset included 3,620 patients (72.1% male) with an average age of 65 ± 12 years. After conducting a binary forward multivariate logistic regression, frailty was not associated with amputation, surgical site infection, or bypass revision. However, frailty at the highest vs lowest RAI score was significantly associated with 3.26 higher times the odds of mortality and 0.32 lower times the odds of being discharged home.</p><p><strong>Conclusion: </strong>Frailty, modeled by the RAI, was demonstrated to be associated with postoperative outcomes in a linear manner in ALI patients undergoing open bypass lower extremity revascularization. Since this is one of the first times a long-term outcomes national database such as the VQI was utilized to study this topic, our research supports the incorporation of the RAI as a screening tool for ALI patients to help guide postoperative care and prognosis and guide shared decision-making in whether to pursue limb salvage or primary amputation.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241301178"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677740","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":"Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers.","authors":"Jason Zhang, Mikel Sadek, Lou Iannuzzi, Caron Rockman, Karan Garg, Allison Taffet, Molly Ratner, Todd Berland, Thomas Maldonado, Glenn Jacobowitz, Frank Ross","doi":"10.1177/15385744241301171","DOIUrl":"https://doi.org/10.1177/15385744241301171","url":null,"abstract":"<p><strong>Objectives: </strong>Total contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD).</p><p><strong>Methods: </strong>This was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention.</p><p><strong>Results: </strong>152 patients underwent TCC. Mean age was 58.8 ± 12.1 years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9 cm², with mean depth 0.61 ± 0.49 cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1 days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, <i>P</i> < .001), intervention (43.4% vs 17.8%, <i>P</i> = .006), and noncompliance (39.1% vs 20.2%, <i>P</i> = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, <i>P</i> < .0001) and incompressible vessels (36.4% vs 7.6%, <i>P</i> < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, <i>P</i> = .0008) compared to patients without intervention.</p><p><strong>Conclusions: </strong>TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241301171"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635377","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 Primary Aortocaval Fistula at the Caval Confluence in a Ruptured Abdominal Aortic Aneurysm.","authors":"Zachary E Williams, Asad Choudhry, Naveed A Rahman, Deena B Chihade, Scott M Surowiec","doi":"10.1177/15385744241300780","DOIUrl":"https://doi.org/10.1177/15385744241300780","url":null,"abstract":"<p><p><b>Background:</b> Primary aortocaval fistulas (ACF) are a rare complication of abdominal aortic aneurysm (AAA), for which treatment options encompass both endovascular and open surgical intervention. <b>Purpose:</b> To report a rare presentation of primary aortocaval fistula. <b>Research Design:</b> Case Report. <b>Study Sample:</b> Single Patient Case. <b>Data Collection and/or Analysis:</b> Single case report. <b>Results:</b> We present a 54-year-old male with a ruptured AAA and associated ACF uniquely located near the caval confluence which was managed through primary endovascular exclusion. Notably, we report significant migration of our graft upon deployment, due to high flow through the ACF. Following a literature review on ACFs, we remark on the anatomic challenges regarding management of an ACF. <b>Conclusions:</b> Awareness of the clinical signs and symptoms remains imperative in proper ACF management given its high mortality.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241300780"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635376","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":"The 'DIMPLE SIGN' of Intra-Aortic Cord.","authors":"Sapna Puppala, Costa Tingirides, James Forsyth","doi":"10.1177/15385744241298984","DOIUrl":"10.1177/15385744241298984","url":null,"abstract":"<p><strong>Background: </strong>With increasing use of imaging to diagnose human pathology, newer aortic anomalies are being identified. An intra-aortic cord is one such abnormality, which requires differentiating from an intimal flap of dissection, to avoid major surgery or prolonged surveillance. The aim of this study was to bring forth a unique feature of the intra-aortic cord on imaging, using volume rendering reformatting and identify similar findings in published literature and hence establish the role of the 'Dimple' sign.</p><p><strong>Methods: </strong>Review of both our institutional imaging (2 cases) as well as the published literature (6 cases), to identify presence of a diagnostic sign that is seen on volume rendered imaging of aorta.</p><p><strong>Results: </strong>The 'Dimple sign' is unique to the intra-aortic cord and is noted on the images of 4 out of 6 prior publications. Two publications did not use volume rendering. Including our cases, the Dimple' sign is seen in 6 out of 8 cases. The Dimple sign arises due to tethering of the cord to the aortic wall leading to umbilication of the aortic wall inwards.</p><p><strong>Conclusions: </strong>The Dimple sign can be very easily noted on volume and/or cinematic rendering and is a useful sign to diagnose an intra-aortic cord and help differentiate it from an intimal flap.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241298984"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577362","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":"Resecting Lower Segment Inferior Vena Cava Leiomyosarcoma With Middle Segment Extension While Avoiding Renal Morbidity.","authors":"Naveen Kumar Kushwaha, Pradeep Jaiswal, Vijay Pratap Singh, Pawan Kumar Dhaman","doi":"10.1177/15385744241276607","DOIUrl":"10.1177/15385744241276607","url":null,"abstract":"<p><p>Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and aggressive mesenchymal tumor, with less than 400 reported cases to date. Complete resection of the tumor with clear margins is the only proven curative treatment, providing survival benefits. Nonetheless, leiomyosarcomas in the middle segment or those extending up to it within the inferior vena cava (IVC) frequently necessitate renal reimplantation or nephrectomy, with rates varying between 56% and 75%. In this case report, we present a 65-year-old female with lower segment IVC leiomyosarcoma with middle segment extension, successfully resected and reconstructed while avoiding associated renal reimplantation or nephrectomy morbidity.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"871-875"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001675","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":"Mean Pressure Gradient and Fractional Flow Reserve at A Superficial Femoral Artery Dissection after Drug-Coated Balloon Angioplasty.","authors":"Taira Kobayashi, Takashi Fujiwara, Masaki Hamamoto, Takanobu Okazaki, Ryo Okusako, Tomokazu Yamaguchi, Naohide Sugawara, Mayu Tomota, Shinya Takahashi","doi":"10.1177/15385744241275055","DOIUrl":"10.1177/15385744241275055","url":null,"abstract":"<p><strong>Objectives: </strong>Residual dissection is a concern in endovascular treatment with a DCB, and there is limited knowledge of hemodynamics at a dissection lesion. Therefore, the objective of this study is to evaluate the mean pressure gradient (MPG) and fractional flow reserve (FFR) at a residual dissection after DCB angioplasty for the superficial femoral artery (SFA).</p><p><strong>Methods: </strong>A total of 59 cases with residual SFA dissection treated with DCB angioplasty at a single center were analyzed retrospectively. The dissection was classified into 6 types (A-F). The primary endpoints were MPG and FFR at a residual dissection lesion after DCB angioplasty, using evaluation with a pressure wire.</p><p><strong>Results: </strong>The median lesion length was 70 (40-130) mm with 24% popliteal involvement, and 11 cases (18%) had chronic total occlusion. A completion angiogram revealed dissection of types A (n = 33, 56%), B (n = 18, 31%), C (n = 7, 12%), and D (n = 1, 2%). The median MPGs in type A, B, and C cases were 0 (0-2), 0 (0-4), and 3 (0-6) mmHg, with a significant lower in type C cases than in type A cases (A vs C, <i>P</i> = .021). The median FFRs in type A, B, and C cases of 1.0 (.98-1.00), 1.0 (.96-1.00), and .98 (.95-1.00) did not differ significantly among dissection types (A vs B, <i>P</i> = .86; A vs C, <i>P</i> = .055; B vs C, <i>P</i> = .15).</p><p><strong>Conclusions: </strong>This is the first report of hemodynamics at a SFA dissection. The results suggest that low-grade dissection (types A or B) does not affect MPG and FFR at a SFA lesion. This indicates that a bailout stent may be unnecessary for patients with dissection of types A or B. A further investigation is needed to determine whether a scaffold is required for a SFA lesion with type C dissection.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"818-824"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977610","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 Situ Needle Fenestration during Thoracic Endovascular Aneurysm Repair: Successful Fenestration of Two Overlapping Thoracic Stent Grafts.","authors":"Georgios S Sfyroeras, Eleni Georgiadi, Georgia Papavasileiou, Stavros Spiliopoulos, John D Kakisis","doi":"10.1177/15385744241273434","DOIUrl":"10.1177/15385744241273434","url":null,"abstract":"<p><p>Endovascular stent grafting is becoming more common in treating complex thoracic aortic aneurysms and dissections. When it becomes necessary to cover the supra-aortic vessels, maintaining blood supply through the supra-aortic branches can be achieved by performing in situ needle fenestration. We present a case of a 65-year-old man with a type B aortic dissection that extended from the origin of the left subclavian artery. A stent graft was inserted into the thoracic aorta distally of the origin of the left common carotid artery. Due to the stent graft moving distally and not adequately sealing the subclavian artery, a second stent graft was placed more proximally. Both stent grafts were successfully in situ fenestrated using a needle, and a stent graft was inserted into the subclavian artery. In conclusion, during thoracic endovascular aortic repair, in situ needle fenestration can be successfully carried out on two overlapping thoracic stent grafts.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"866-870"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006211","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}