Vasa-european Journal of Vascular Medicine最新文献

Background: Vascular access-site complications after catheterization remain a significant cause of morbidity and mortality. While patient- and procedure-related risk factors are well described, the impact of structured, interdisciplinary training programs is less well established. We evaluated the effect of a structured training program for cardiologists and interventional staff on access-site-related complications after transfemoral coronary interventions. Patients and methods: Over 36 months, we tracked all elective transfemoral coronary interventions at our institution. After an initial 6-month observational phase, we implemented a structured training program for cardiologists and catheter lab staff, using initial complication rates as the baseline. The training included quarterly sessions, pre-interventional angiological assessment for high-risk patients, pre-interventional assessment for all patients, and sheath removal by assistants. We prospectively assessed all access-site related complications using a standardized protocol and analysed incidence changes with a regression model, adjusting for patient-specific risk factors over time. Results: Quarterly training and pre-interventional angiological assessment for high-risk patients did not significantly impact complication rates. However, pre-interventional angiographical assessment for all patients and sheath removal training for assistants significantly reduced complication rates. The results remained consistent after adjusting for patient-specific risk factors. Conclusions: Structured angiological training for interventional staff significantly reduces access-site related complications. Interdisciplinary collaboration enhances patient safety and minimizes adverse events.

Background: To compare the effects of conventional approaches based on compression stockings and preventive measures with a combined program including these techniques, together with therapeutic exercise and self-manual lymphatic drainage instructed by a physiotherapist on functionality, general physical activity, and oedema in individuals with chronic venous insufficiency. Patients and methods: A randomized controlled clinical trial with two parallel groups (conventional approach and conventional plus physiotherapy approach) and a single-blind design was conducted. Oedema (circumferences), functionality (6-Minute Walking Test and the Five-Repetition Sit-to-Stand Test), physical activity level (International Physical Activity Questionnaire), and prevention measures were assessed before and after the intervention. Repeated measures ANOVA was used for statistical analysis. A total of 55 participants composed the final sample (13 women and 42 men, mean age: 60.49 years [15.05]). Results: No significant changes were found for the main effect of time or group-time-adherence interaction in any variable, while circumference at 10, 20, and 30 cm from the heel in both legs, and the 6-Minutes Walking Test showed a significant main effect for time in the conventional-approach group with high adherence. Conclusions: A multicomponent approach combining physiotherapy and medicine does not appear to be better than the conventional approach applied at primary care centres for improving functionality and oedema in patients with chronic venous insufficiency.

Background: Patients with intermittent claudication (IC) need lifelong treatment with secondary prevention, including smoking cessation, physical activity, and best medical treatment. The deficiency in existing support indicates a need for new strategies to improve self-management of the disease. However, knowledge of electronic health (e-health) as support for these patients is lacking. The primary aim was to evaluate the effect on secondary prevention outcomes and the usability of a web-based application for patients with IC. The secondary aim was to describe the patients' experiences of using a web-based application. Patients and methods: Patients with IC (n=34) were recruited from a vascular outpatient clinic to a randomized controlled pilot trial. The study population had a mean age of 73 years and 52.9% were women. For three months, the intervention group (n=18) reported information through/via the application about physical activity, smoking, medication therapy, blood pressure, pain after activity, and quality of life (QoL). Primary outcome was walking distance, and the secondary outcome included ankle brachial index (ABI), blood pressure measurements, lifestyle factors, health education, and QoL. A linear mixed model was used to determine how the intervention affected the progression of walking distance, ABI, blood pressure measurements and BMI and Wilcoxon signed ranked test for QoL. After completing the study, the intervention group was interviewed in focus groups. Results: The reporting adherence was high (86-93%). QoL were improved in the intervention group (p=.049), and the level of insight into their condition increased in both intervention- (p=.016) and control group (p=.014). No significant differences in variables walking distance, ABI, blood pressure or BMI were observed between the groups. The interviews show an overall positive experience of using the application. Some patients experienced that the application increased their motivation to adhere to lifestyle recommendations. Conclusions: High reporting adherence and improved QoL, together with the participants experiences, indicate that using e-health may support adherence to secondary prevention in patients with IC but needs to be further studied in a full-scale randomized controlled trial.

Background: Radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) have emerged as less invasive alternatives to traditional surgical interventions, offering reduced recovery times and comparable efficacy. This study aims to compare the efficacy, safety, and patient-reported outcomes between RFA and MOCA in treating SSV insufficiency. Materials and methods: this is a retrospective, nonrandomized study that involved patients who underwent either RFA or MOCA between 2015 to 2019. Data collected included demographics, clinical grading, procedural specifics, and follow-up outcomes. The primary endpoint was the comparison of freedom from recanalization and freedom from reinterventions rates, while secondary endpoints focused on recurrences rates and clinical outcomes assessed by revised clinical severity score (rVCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ). Results: A total of 132 limbs were treated (n=72 RFA; n=60 MOCA). Baseline demographics and clinical severity were comparable between groups. At 5 years, freedom from recanalization rate was significantly higher in the RFA group compared to the MOCA group (91.7% vs 66%; p=.0014). Clinical recurrence rates at 5 years were 11.7% for RFA and 22% for MOCA (p=.0023), while freedom from reintervention rates were 93.3% and 72.7%, respectively (p=.0011). Although both groups showed clinical improvement over time, patients treated with MOCA exhibited a significant worsening in rVCSS and AVVQ at 3 and 5 years compared to the RFA group (p<.0001). Conclusions: RFA demonstrates greater long-term stability, lower recurrence and reintervention rates compared to MOCA, suggesting it may be a preferable option for SSV insufficiency treatment in terms of durability and patient outcome.

Background: To compare atherectomy-assisted endovascular revascularization with balloon angioplasty for the treatment of common femoral artery disease (CFAD). Materials and methods: In a multi-centre retrospective research collaborative, data from consecutive patients who underwent endovascular revascularization of the groin were analysed. Primary endpoints were clinically driven target-lesion-revascularization (CD-TLR) and improvement of clinical symptoms by Rutherford categories (RC). Kaplan-Mayer analyses were used to evaluate these endpoints over time in patients undergoing atherectomy-assisted versus conventional endovascular treatment. In addition, retrospective case-control matching was performed, considering patient and lesion specific characteristics. Lesion calcification was assessed using the PACSS scoring system. Results: Of 225 patients, 179 (79.6%) underwent atherectomy-assisted treatment, whereas 46 (20.4%) underwent balloon angioplasty. Mean age was 72.0 (66.0-79.0) yrs, 139 patients (61.8%) had intermittent claudication and 84 (37.3%) had chronic limb-threatening ischemia (CLTI). Involvement of the deep femoral artery femoral was present in 137 (60.9%) cases, whereas lesion calcification was moderate to severe (PACSS 2-4) in most cases (88%). Atherectomy had low complication rates (perforation in one (0.6%) patient and distal embolization requiring re-intervention in 2 (0.9%) patients) and lower rates of bail-out stenting compared to angioplasty (5.1% versus 36.7%, p<.0001). No perforation or distal embolization was observed in the angioplasty group. After matching for patient and lesion characteristics CD-TLR (HR=4.0, 95%CI=1.0-15.0, p<.05) and RC improvement rates both favoured atherectomy (93.5% versus 73.1%, p<.05). Conclusions: Atherectomy-assisted endovascular revascularization of CFAD seems to be associated with lower stent placement and re-intervention rates compared to balloon angioplasty. Future prospective trials with longer follow-up duration are now warranted.

Background: Endovascular treatments in emergency or bailout situations focusing on anatomical regions with high extension and flexion movement remain a key area of interest. To date, the main field of application of the GORE^® VIABAHN^® VBX Balloon Expandable Endoprosthesis (VBX) (Gore, USA) has been in complex iliac occlusions and aortic pathologies. This retrospective study aimed to assess the safety and effectiveness of the VBX in a real-world patient population at a single centre, focusing on anatomical regions under high mechanical stress. This study presents the first data set for the VBX beyond its use in aortic and iliac pathologies. Materials and methods: In this retrospective monocentric study, all patients included had a Gore^® Viabahn^® balloon expandable (VBX^®) implanted at a tertiary referral hospital during the observation period 02/2020 to 03/2024. Results: The median population age was 69 years, and eight patients were female. The mean Body Mass Index was 26,2±4,9 kg/m². Eleven patients were treated in the inguinal region, nine in the shoulder region, and two in the knee region. The most common indications for implantation were stenosis (9/21) and bleeding (6/18). Eleven patients had an urgent need for implantation. Technical success was 100%. No stent-associated complication was observed. The 30-day mortality rate was 0%. The median follow-up time for all patients was 230 days (27-1064 d). Primary patency for all patients was 95,2%, while secondary patency was 100%. Conclusions: The VBX represents a safe and easy-to-use stent graft for managing complications, even in challenging anatomy regions.

When a peripheral arterial stenosis/occlusion can be crossed by a guidewire, but no device can follow over it, to have proficiency in bailout strategies which allow device crossing can be beneficial. Limited information is available on these bailout manoeuvres. This article aims to provide a comprehensive pictorial review of various bailout techniques, equipping operators with an algorithm to apply in specific scenarios, to eventually improve procedural success rates.

Background: To evaluate the safety and efficacy of direct retrograde stent punctures for crossing of chronic total occlusions in patients with symptomatic peripheral arterial disease. Methods: A retrospective registry of consecutive patients treated with retrograde recanalization techniques in five high-volume German centers was performed. Patient cases with attempted retrograde after failed antegrade revascularization were studied. Primary endpoint was technical success. Secondary endpoints were access vessel complications, need for bail-out procedures and major or minor amputation. Results: Of the 1516 retrograde punctures recorded in the registry, 63 (4.2%) were direct stent punctures. Superficial femoral artery stents were punctured in 88.9% (56/63) of the cases, tibial artery stents in 6 patients (9.5%) and a stent in an occluded femoropopliteal bypass in one case (1.6%). Mean lesion length was 322±125 mm. Stent puncture was successful in 62 cases (98.4%) and the procedural success rate was 96.8% (61/63) with one technical failure despite successful puncture. A sheathless approach was performed in 79.4% (50/63) of cases. Drug-coated balloon angioplasty was applied in 63.5% (40/63) and new stenting (bare-metal or drug-eluting) in 55.6% (35/63) of lesions. One minor and no major amputations were recorded in the first 30 days after the procedure. A sheathless retrograde approach was associated with significantly higher procedural technical success (p = .04). Conclusion: Retrograde femoral or tibial direct stent puncture seems to be safe and effective for the recanalization of chronic total occlusions of the femoropopliteal segment in cases where antegrade recanalization is deemed unsuccessful.