Vasa-european Journal of Vascular Medicine最新文献

Background: Bilateral symptoms of peripheral artery disease may be rarely caused by isolated atherosclerotic aortic stenosis or short occlusion. Standard therapies have been open surgery, balloon angioplasty and implantation of selfexpanding stents and stentgrafts. Materials and methods: In this retrospective study 54 consecutive patients were treated under local anaesthesia with a balloon-expandable endograft. Endpoints were safety, ankle-brachial and toe-brachial index (ABI, TBI), walking distance, clinical stage and re-interventions at long-term. Results: There were 36 women and 18 men, mean age 68 years; 48 patients suffered from claudication, 6 patients had rest pain with skin lesions in 3 cases. The technical success rate was 100%. There was an immediate average improvement of ABI from 0.76 +/- 0.26 at rest before intervention to 0.88 +/- 0.31 at rest after stentgraft implantation into the aortic stenosis. TBI improved from 0.48 +/- 0.17 to 0.58 +/- 23 at rest. Mean follow-up was 1 to 8 years (mean 4.46) years. Average walking distance improved from 124 m to 612 m. Of the 6 patients with rest pain or skin lesions all except 1 patient improved to at least claudication stage with a painfree walking distance over 200 m. No complications such as aortic rupture, dissection or peripheral embolisation occurred, 2 patients needed surgical revision of their calcified common femoral arteries at the access sites. Three patients developed at long-term recurrent stenosis due to the compression of stentgrafts by the calcified plaque burden which was solved by balloon angioplasty or implantation of an additional aortic stentgraft. Conclusions: Endovascular treatment of aortic stenosis or occlusion is feasible under local anaesthesia with good functional results, very low mortality and morbidity and durable results.

Background: Coral reef atherosclerosis of the renovisceral aorta leads to end-organ and extremity malperfusion due to ischaemia and/or embolic events. Those mostly female patients typically present with renovascular hypertension, chronic mesenteric ischaemia, and symmetric peripheral artery disease of all stages, including critical limb ischaemia. Mortality and morbidity are high in open surgery. Materials and methods: Here we describe step by step the individually designed endovascular solutions with multiple arterial accesses using stentgrafts and open stents in 8 consecutive patients. Results: All patients survived, acute renal failure occurred in 1 case, otherwise uneventful inhospital courses. Patients were followed over 25 (7-56) months with durable results. Conclusions: Endovascular treatment of coral reef aorta leading to aortic stenosis or occlusion in the renovisceral segment is feasible in most cases using multiple arterial accesses with good functional results, low mortality and morbidity and durable results.

Background: The aim of this study was to determine whether the on-site availability of treatment options (carotid endarterectomy CEA, carotid artery stenting CAS) was associated with patient and hospital characteristics, medical management and outcome. Materials and methods: This study is a pre-planned sub study of the Integration and Spatial Analysis of Regional, Site-specific, and patient-level factors for Improving Quality of treatment for carotid artery stenosis (ISAR-IQ) project, which analysed data from the nationwide German statutory quality assurance carotid database. Hospitals were categorized according to on-site availability of: CEA-only, CAS-only, and both CEA and CAS centre. Primary outcome event was any in-hospital perioperative stroke or death. The multivariable regression analysis was adjusted for age, sex, American Society of Anesthesiologists Physical Status (ASA stage), symptomatic status, antiplatelet therapy, ipsilateral and contralateral degree of stenosis, pre- and post-procedural assessment by a specialist in neurology, and hospital volume. Results: A total of 201,330 patients undergoing CAS or CEA for asymptomatic or symptomatic carotid stenosis between 2012 and 2018 were included. 74% were treated in hospitals that offer both methods, 24% in CEA-only centres and 2.5% in CAS-only centres. The median annual number of cases for CEA and CAS was 44 and 7, respectively, in centres that offered both compared to 16 and 6 in centres that performed either CEA or CAS, respectively. The overall stroke and death rate until hospital discharge was 2.1%. In centres providing both CEA and CAS, the stroke and death rates were 2.0% for CEA and 2.4% for CAS. These figures were 2.0% in centres providing CEA-only and 3.0% for CAS-only centres. The multivariable regression analysis showed significant higher perioperative stroke or death rate in the CEA-only group (adjusted Odds Ratio aOR=1.12, 95%-confidence interval (CI) 1.03-1.21) and CAS-only group (aOR=1.26, 95%-CI 1.04-1.52) versus the combined CEA and CAS group. Conclusions: Centres providing both CEA and CAS had a lower risk of perioperative stroke and death than centres performing CEA-only or CAS-only. The minimum volume recommendations of the national guideline were not achieved in the median by CEA-only and CAS-only centres. This could be a starting point for public health measures to increase guideline conformity and treatment quality.

Background: To evaluate the short-term outcomes of a novel, customized multibranched G-Branch endograft for the treatment of thoraco-abdominal aortic aneurysm (TAAA) and juxta/pararenal abdominal aortic aneurysm (J/PAAA). Patients and methods: Between July 2023 and May 2025, 50 patients (mean age 72 years; 45 men) were treated with implantation of a customized G-Branch endograft (Lifetech Scientific, Shenzhen, China) at four European regional vascular centres. The mean aneurysm diameter was 65.7 mm (range, 55-90 mm). Depending on the size and extent of the aortic pathology, 19 patients had J/PAAA and 31 had TAAA. Three patients had concomitant common iliac artery aneurysms, and one patient had a concomitant arch aneurysm. All patients underwent either an elective one-stage repair (30 patients, 60%) or a staged repair (20 patients, 40%) according to the local protocol of each centre. Multicentre outcome data were prospectively collected and retrospectively analysed. Perioperative results were assessed before discharge and during follow-ups at 1, 6, and 12 months. Results: Technical success was achieved in 96% (48/50) of patients. In-hospital mortality was 4% (2/50). Early perioperative complications occurred in six patients (11%), with no spinal cord ischemia. Over a mean follow-up of 7 months (range, 1-23 months), two patient (4%) required an unplanned late reintervention with branch extension or relining due to a type Ic and IIIb endoleaks, respectively. Of the 198 target vessels, all remained patent, yielding an overall freedom from branch instability of 99%. No patients died due to aneurysm- or procedure-related causes; one patient died 8 months postoperatively due to a major stroke. All remaining 47 patients were doing well at the last follow-up. Conclusions: Our preliminary experience with the G-Branch endograft appears safe and yields high technical success with encouraging short-term outcomes for the endovascular repair of J/PAAA and TAAA. Continued patient surveillance and extended follow-up are essential to confirm these results.

Background: To assess long-term patency rates, clinical outcomes, and device-related adverse events associated with the use of a dedicated woven nitinol venous stent following venoplasty to treat patients with symptomatic iliac and femoral vein obstruction. Material and methods: This single-center, single-arm, observational study consisted of 25 patients with iliofemoral vein obstructions caused by residual thrombosis, non-thrombotic compression, or post-thrombotic stenosis. Lesions were treated with the blueflow Venous Stent, a closed-cell stent made of woven strands of Nitinol wire. Primary outcome measures were primary patency and sustained clinical success at 3 months while secondary clinical measures included the revised Venous Clinical Severity Score (rVCSS), Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification, and the number of device-related adverse events through 60 months. Results: Primary patency was 94.7% and sustained clinical success was 76.5% at 3 months. Primary patency was 95.2% and 70% while sustained clinical success was 76.2% and 70% at 12 and 60 months. The mean rVCSS was 7.4 ± 4.0 at baseline, 5.3 ± 1.8 at 3 months, 4.6 ± 1.4 at 12 months, and 2.6 ± 0.9 at 60 months. CEAP classifications at baseline were predominantly C3 (52%) while 36%, 52%, and 40% of scores were C1-C2 at 3, 12, and 60 months. One device-related adverse event (i.e., in-stent restenosis) was reported resulting in reintervention. There were three patient deaths: two from the progression of metastatic cancer and one from a bicycle accident. Conclusions: This exploratory study demonstrated a primary patency rate of 94.7% and a clinical success rate of 76.2% at 3 months. Patency was 70% with a 65% reduction in the mean rVCSS score from baseline at 5 years (-5.2). The blueflow Venous Stent performed adequately with no safety concerns when used for its intended indication.

Background: Although venous stent placement is an established treatment for patients with deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS), stent patency rate may be as low as 80% at 12 months. Treatment of stent occlusion requires the removal of a large amount of fresh or organized thrombus from stents with a diameter of 12-20 mm. The feasibility of large-bore rotational thrombectomy in combination with angioplasty to treat thrombosed venous iliofemoral or inferior vena cava stents has not been investigated yet. Patients and methods: Between May 2023 and June 2024, 12 patients (15 limbs) with symptomatic venous stent occlusions were treated at our institution with the 10-French Rotarex™ thrombectomy device and completed 3-month follow-up by Duplex ultrasound. The primary outcome was primary patency at 90 days after thrombectomy of stent occlusion. Safety outcomes included device-related complications, bleeding, and death. Results: Median age was 41 years, 75% were women. At the index procedure, 10 (83%) patients presented with PTS and two (17%) with acute DVT. Median time from index procedure to re-intervention was 1125 (Q1-Q3: 897-2297) days and from symptom onset to re-intervention 39 (Q1-Q3: 8-186) days. Technical success of re-intervention was achieved in all cases, and bail-out stent-in-stent placement was not required in 5 (33%) limbs. The primary patency rate at 90 days was 86.7% (95% CI: 71.0-100.0). Two (17%) patients experienced recurrent stent thrombosis and were managed conservatively. Peri-interventional minor bleeding occurred in two (17%) patients. There were no device-related complications, major bleeding, or deaths. Conclusions: Large-bore rotational thrombectomy appears to be a feasible strategy to treat iliofemoral and inferior vena cava stent thrombosis, achieving acceptable short-term patency without major adverse events.

Background: Non-adherence to guideline-directed best medical therapies is prevalent in people with lower extremity peripheral arterial disease (PAD), constituting a significant challenge to effective treatment. Underlying drivers for non-adherence remain poorly understood. This study explored patients' health-related beliefs and behaviours regarding antithrombotic and lipid-lowering therapy to identify opportunities for improvement. Patients and methods: Using a qualitative design, we conducted semi-structured interviews with patients with symptomatic PAD based on a purposeful sampling strategy. Patients were recruited from four vascular surgery departments in Denmark between December 2022 and January 2024, excluding those with cognitive impairment or terminal illness. Data were analysed using framework analysis based on the six domains of the Health Belief Model (HBM): perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Results: Sixteen patients participated (median age: 69 years, 38% women); 68.8% had intermittent claudication, 18.8% had chronic limb-threatening ischemia, and 12.5% had undergone major amputation. Seven patients were adherent, and nine were non-adherent to secondary preventive therapy. Patients expressed low perceived awareness of PAD severity and its cardiovascular implications. Their perception of PAD centred around leg pain and its impact on everyday life, limiting their understanding of the benefits of secondary preventive therapies. Patients lacked knowledge about treatment goals and did not link secondary preventive therapy with PAD. Adherence barriers included inadequate understanding of PAD's chronic progressive nature, concerns about side-effects, prescription confusion, and financial constraints. Internal adherence triggers included fear of recurring pain, complications, and early death. External cues to action included a trusting patient-provider relationship and receiving comprehensive, understandable information. Conclusions: This study highlights the multifaceted challenges hindering adherence to antithrombotic and lipid-lowering therapies. Addressing the limited disease awareness and the expressed need for patient-centred communication delivered in a trusting patient-provider relationship could serve as starting point for future strategies to improve adherence.