Vascular and Endovascular Surgery最新文献_第2页

Open Surgical Repair in a Patient With Loeys-Dietz Syndrome and Extensive Vascular Compromise: A Case Report and Literature Review 一名洛伊-迪茨综合征和大面积血管损伤患者的开放手术修复：病例报告和文献综述

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-09-10 DOI: 10.1177/15385744241284383

Camilo A. Polania-Sandoval, Houssam Farres, Santh Prakash Lanka, Young Erben

Loeys-Dietz syndrome (LDS) has been associated with multiple vascular abnormalities involving the entire arterial tree. However, limited reports regarding compromise in the aortoiliac and femoral bifurcation are available. Further, recommendations for optimal approach, thresholds for diameter at the time of surgery, and surveillance are also limited. We present a case of a 67-year-old male patient with LDS and aneurysmal aortoiliac and enlarging common femoral arteries aneurysms, who underwent open surgical repair. His past surgical history included multiple vascular interventions for lower extremity claudication and bilateral hip replacements. The right hip arthroplasty was previously removed due to infection. From the vascular standpoint, the patient underwent staged endovascular left hypogastric artery embolization and open aorto-bi-profunda bypass with a Rifampin-soaked Dacron graft. At 5-month follow-up, he remains asymptomatic with healed incisions and patent bypasses. This case highlights the challenges in managing peripheral aneurysms in LDS patients, emphasizing the need for tailored treatment strategies. While open repair is preferred, endovascular options may be considered in selected cases. Surveillance remains critical with annual cross-sectional imaging. Surgical planning is intricate due to comorbidities, anatomical complexities, and previous surgical infection. Surveillance of these patients must be strict as multiple vascular and non-vascular complications may arise. Therefore, collaborative decision-making is essential for optimal outcomes in this known high-risk population with connective tissue disorders.

Loeys-Dietz 综合征（LDS）与涉及整个动脉树的多种血管异常有关。然而，有关主动脉髂动脉和股动脉分叉受损的报告却很有限。此外，关于最佳手术方法、手术时直径阈值和监测的建议也很有限。我们介绍了一例 67 岁男性患者的病例，他患有 LDS 和动脉瘤性主动脉髂动脉瘤和股总动脉瘤，并接受了开放手术修复。他的既往手术史包括多次血管介入治疗下肢跛行和双侧髋关节置换术。右侧髋关节置换术曾因感染而被切除。从血管角度来看，患者接受了分阶段的左胃下动脉血管内栓塞术和使用利福平浸泡过的达克龙移植物的开放式主动脉-双股浅动脉搭桥术。随访 5 个月后，患者仍无症状，切口愈合，旁路通畅。这个病例凸显了 LDS 患者外周动脉瘤治疗的挑战，强调了定制治疗策略的必要性。虽然开放性修复是首选，但在选定的病例中也可以考虑血管内治疗方案。每年进行横断面成像监测仍然至关重要。由于合并症、解剖复杂性和既往手术感染等原因，手术规划非常复杂。由于可能出现多种血管和非血管并发症，因此必须对这些患者进行严格监控。因此，对于这种已知的结缔组织疾病高危人群，合作决策对于获得最佳治疗效果至关重要。

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引用次数: 0

Endovascular Treatment of Aortoiliac Aneurysms With the Bell-Bottom Technique: A Systematic Review and Meta-Analysis 用钟罩底技术进行主动脉髂动脉瘤的血管内治疗：系统回顾与元分析

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-09-10 DOI: 10.1177/15385744241284071

Panagiotis Volteas, Stefanos Giannopoulos, Georgios Koudounas, Anthony Asencio, Anirudh Chandrashekar, Christos Karkos, Dimitrios Virvilis

ObjectiveAneurysmal degeneration of the common iliac artery (CIA) can pose a challenge to achieve distal landing zone sealing at the time of endovascular abdominal aortic aneurysm repair (EVAR). The aim of this study was to summarize the current literature regarding the bell-bottom technique (BBT) for ectatic CIAs during EVAR.MethodsThis study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible articles were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until April 2023. A meta-analysis was conducted using the random effects model and the I2 statistic was used to assess for heterogeneity. The primary endpoints were type Ib/III endoleak, graft occlusion/limb embolization, and reintervention rate. Secondary endpoints included perioperative adverse events and mortality.ResultsOverall, twenty-six studies and 4332 patients with flared limbs were included. The pooled estimate for type Ib/III endoleak was 4% (95% CI: 2-6, I2 = 85.6%), for reintervention rate was 9% (95% CI: 6-12, I2 = 90.4%), and for overall mortality was 10% (95% CI: 4-19, I2 = 97.3%). No aneurysm related deaths were recorded. Comparative analysis showed similar type Ib/III endoleak, graft occlusion, and reintervention rates between the EVAR BBT, iliac branch endoprosthesis (IBE), and embolization of the internal iliac artery followed by extension of the iliac limb to the external iliac artery (EIE) groups.ConclusionsThe use of flared limbs could be considered a reasonable first line choice for EVAR cases with CIA ectasia as it is simpler, allows for future IBE or EIE and does not increase the risk for type Ib/III endoleak or graft occlusion. Further comparative studies with longer follow-up are needed.

目的髂总动脉（CIA）的动脉瘤变性会给血管内腹主动脉瘤修补术（EVAR）时实现远端着床区密封带来挑战。本研究旨在总结目前有关EVAR期间钟底技术（BBT）治疗异位CIA的文献。通过对截至 2023 年 4 月出版的 PubMed、Scopus 和 Cochrane Central 进行全面检索，确定了符合条件的文章。采用随机效应模型进行荟萃分析，并使用 I2 统计量评估异质性。主要终点为Ib/III型内漏、移植物闭塞/肢体栓塞和再介入率。次要终点包括围手术期不良事件和死亡率。结果共纳入了 26 项研究和 4332 例扩创肢体患者。Ib/III型内漏的汇总估计值为4%（95% CI：2-6，I2=85.6%），再介入率为9%（95% CI：6-12，I2=90.4%），总死亡率为10%（95% CI：4-19，I2=97.3%）。没有与动脉瘤相关的死亡记录。比较分析显示，EVAR BBT组、髂支内膜假体组（IBE）和髂内动脉栓塞后将髂肢延伸至髂外动脉组（EIE）之间的Ib/III型内漏、移植物闭塞和再介入率相似。结论对于有CIA异位的EVAR病例，使用外展髂肢可被视为合理的一线选择，因为这种方法更简单，允许将来使用IBE或EIE，而且不会增加Ib/III型内漏或移植物闭塞的风险。还需要进行更长时间的随访比较研究。

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引用次数: 0

Management of an Iatrogenic Pulmonary Artery Rupture via Balloon Tamponade 通过球囊填塞处理先天性肺动脉破裂

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-04-30 DOI: 10.1177/15385744241251643

Mohammad Yassen, Khalid Changal, George V. Moukarbel

Pulmonary artery rupture is a rare complication of right heart catheterization characterized by a rapid clinical deterioration and high mortality rate. We present the case of an 89-year-old woman with severe symptomatic aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement. The patient had acute cardiopulmonary deterioration due to pulmonary artery rupture at the time of right heart catheterization, that was successfully sealed by balloon tamponade.

肺动脉破裂是右心导管检查的一种罕见并发症，其特点是临床症状迅速恶化，死亡率高。我们报告了一例 89 岁女性患者的病例，她患有严重的症状性主动脉瓣狭窄，在主动脉瓣置换术前接受了心导管检查。患者在接受右心导管检查时因肺动脉破裂而导致心肺功能急性恶化，经球囊填塞成功封堵了肺动脉。

引用次数: 0

Distal Forearm Arteriovenous Fistula Maturation in Diabetic Hemodialysis Patients 糖尿病血液透析患者的前臂远端动静脉瘘成熟度

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-04-29 DOI: 10.1177/15385744241251653

Pouya Tayebi, Kosar Dadashi, Masoumeh Asgharpour, Ali A. Moghadamnia, Hemmat Gholinia, Ali Bijani

PurposeAtherosclerotic disease of the forearm arteries can impede the maturation of distal fistulas in diabetic patients. The goal of this study was to look at the maturity of diabetic hemodialysis patients’ distal forearm (radiocephalic snuffbox or distal forearm) arteriovenous fistulas.Materials and MethodsPatients with chronic renal failure who were candidates for distal forearm radiocephalic arteriovenous fistula implantation were evaluated in this cross-sectional study. Patients’ demographic details, underlying disorders, laboratory measurements, vital signs, and information on their surgery were all noted. Patients were checked for fistula development 1 week, 1 month, 2 months, and then monthly until 6 months after surgery. Arteriovenous fistula maturation characterized by optimal blood flow, vessel dilation, and structural adaptations.ResultsAmong 343 patients (56% male, 44% female, mean age: 57.32 ± 12.48 years), hypertension prevailed (81.9%), followed by hyperlipidemia (42.3%) and coronary artery disease history (25.9%). AVFs achieved 58.3% maturation in 64.98 ± 11.05 days; higher BP during creation correlated with successful maturation (17.02 ± 1.46 mmHg vs 13.90 ± 1.93 mmHg, P < .05). No significant statistical difference found in distal forearm arteriovenous fistula maturation between males (57.8%) and females (58.9%) ( P > .005). However, 41.7% of AVFs failed in 18.83 ± 17.89 days. Failed AVFs exhibited lower BP during operation and failure (11.75 ± 1.86 mmHg). Kaplan-Meier analysis depicted maturation probabilities over 90 days post-surgery.ConclusionDiabetes and patient sex did not affect the maturation time of distal forearm AVFs in hemodialysis patients. Increased blood pressure during and after surgery correlated with shorter maturation time.

目的糖尿病患者前臂动脉粥样硬化性疾病会阻碍远端瘘管的成熟。本研究旨在观察糖尿病血液透析患者前臂远端（射频消融术或前臂远端）动静脉瘘的成熟情况。患者的详细人口统计学资料、基础疾病、实验室测量、生命体征和手术信息均被记录在案。分别在术后 1 周、1 个月、2 个月和 6 个月前每月检查患者的瘘管发育情况。结果 343 名患者（56% 为男性，44% 为女性，平均年龄：57.32 ± 12.48 岁）中，高血压患者占多数（81.9%），其次是高脂血症（42.3%）和冠心病史（25.9%）。动静脉瘘在 64.98 ± 11.05 天内达到 58.3% 的成熟度；创建期间较高的血压与成功成熟度相关（17.02 ± 1.46 mmHg vs 13.90 ± 1.93 mmHg，P < .05）。男性（57.8%）和女性（58.9%）的前臂远端动静脉瘘成熟度无明显统计学差异（P > .005）。然而，41.7%的动静脉瘘在 18.83 ± 17.89 天内失败。失败的 AVF 在手术和失败期间的血压较低（11.75 ± 1.86 mmHg）。结论糖尿病和患者性别不会影响血液透析患者前臂远端动静脉瘘的成熟时间。术中和术后血压升高与成熟时间缩短有关。

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引用次数: 0

Safety and Effectiveness of Abre Self-Expanding Venous Stent for Treatment of Superior Vena Cava Syndrome Abre 自扩张静脉支架治疗上腔静脉综合征的安全性和有效性

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-04-27 DOI: 10.1177/15385744241251638

Thomas J. An, Stephanie L. McNamara, Ali Ardestani, Omar Zurkiya, Alexis Cahalane, Michael S. Stecker, Yan Epelboym, Ezra Burch, Khanant Desai, Sanjeeva P. Kalva

PurposeSuperior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA).MethodsAn institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty.ResultsPrimary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30 days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1 days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention.ConclusionsTreatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study.

目的上腔静脉（SVC）综合征是由部分或完全SVC阻塞引起的一系列症状。血管内上腔静脉支架植入术是治疗上腔静脉综合征的有效方法，临床疗效快，并发症风险低。在本研究中，我们评估了一组使用 AbreTM 自膨胀静脉支架（美敦力公司，美国明尼阿波利斯）治疗的 SVC 综合征患者的技术和临床疗效。方法使用机构数据库回顾性识别 2021-2023 年间使用 AbreTM 静脉自膨胀支架置入治疗的 SVC 综合征患者。从电子病历中获取患者的人口统计学数据、技术结果、治疗效果和不良事件。研究共纳入 19 名患者（平均年龄 58.6 岁）。13例因SVC恶性压迫而进行了介入治疗，5例因中心静脉导管相关的SVC狭窄而进行了介入治疗，1例因血管成形术难治的HD瘘相关的SVC狭窄而进行了介入治疗。两名患者（7%）需要在支架植入术后30天内再次进行溶栓和血管成形术。临床和造影随访的平均时间分别为 228.7 ± 52.7 天和 258.7 ± 62.1 天。所有接受临床随访的患者在干预后临床症状均有明显改善。结论使用 AbreTM 自膨胀静脉支架治疗 SVC 综合征的技术和临床成功率很高。本研究未发现与支架置入相关的并发症。

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引用次数: 0

Robotic Renal Vein Bypass: A Novel Technique for Treating a Challenging Case of Nutcracker Syndrome 机器人肾静脉搭桥术：治疗胡桃夹综合征疑难病例的新技术

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-04-20 DOI: 10.1177/15385744241249291

Asad Choudhry, Daniel DeNoble, Gennady Bratslavsky, Anthony Feghali

This case report highlights the successful application of a robotic-assisted surgical approach in managing Nutcracker syndrome. The patient, a 36-year-old female presented with severe symptoms and underwent robotic left renal vein transposition after failing conservative management. The procedure was performed through a minimally invasive approach utilizing the Da Vinci robotic system™ which offers enhanced visualization and precision. However, challenges arose during the renal vein anastomosis due to tension and poor flow through the transposition, requiring two revisions with a bovine pericardial patch. Ultimately, an 8 mm ringed PTFE bypass was anastomosed from the distal left renal vein to the Inferior Vena Cava. Despite these challenges, the patient experienced a successful outcome with complete symptom resolution of this complicated pathology.

本病例报告重点介绍了机器人辅助手术方法在治疗胡桃夹综合征中的成功应用。患者是一名 36 岁的女性，症状严重，保守治疗无效后接受了机器人左肾静脉转位术。手术采用达芬奇机器人系统（Da Vinci robotic system™）的微创方法进行，该系统具有更强的可视性和精确性。然而，在肾静脉吻合过程中，由于转位处的张力和血流不畅，出现了一些问题，需要用牛心包补片进行两次修补。最终，从左肾静脉远端到下腔静脉吻合了一条 8 毫米环形聚四氟乙烯旁路。尽管遇到了这些挑战，但患者还是获得了成功，这一复杂病变的症状得到了完全缓解。

引用次数: 0

Pharmacological Thromboprophylaxis for VTE Post-Endovenous Ablation of Varicose Veins: Network Meta-Analysis 静脉曲张静脉内消融术后 VTE 的药物血栓预防：网络元分析

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-04-13 DOI: 10.1177/15385744241245079

Daniel Westby, Sara Gasior, Mark Twyford, Megan Power Foley, Aoife Lowery, Stewart R. Walsh

ObjectiveEndovenous ablation has revolutionized treatment of varicose vein surgery but is associated with a risk of venous thromboembolism. There is no consensus regarding anticoagulation protocols for these patients. This network meta-analysis (NMA) aims to identify which anticoagulant is optimal in this cohort for clot prevention with minimal risk of adverse bleeding events.MethodsLibrary databases were searched for studies where patients were treated with one or more anticoagulants following endovenous ablation for varicose veins. The methodological quality of included studies was quantified using the Risk of Bias (ROB) assessment tools. Findings were reported using the meta-analysis of observational studies in epidemiology (MOOSE) checklist. Statistical analysis was carried out using metainsight (rpackage).ResultsObservational data on just under 1500 patients prescribed post ablation anticoagulation (Rivaroxaban, Enoxaparin, Fondaparinux) were analyzed. Patient characteristics were comparable across the cohorts. 81 thrombotic and 40 minor bleeding events occurred in total. Overall rivaroxaban is found to be superior to the other agents.ConclusionsThis NMA indicates that prophylactic rivaroxaban is the highest ranked anticoagulant for thromboprophylaxis in patients post endovenous ablation for varicose veins, with a low risk of adverse bleeding. The choice whether to anticoagulate these patients is likely to remain at the discretion of the treating clinician.

目的静脉腔内消融术彻底改变了静脉曲张手术的治疗方法，但也存在静脉血栓栓塞的风险。关于这些患者的抗凝方案，目前尚未达成共识。本网络荟萃分析（NMA）旨在确定哪种抗凝剂是该人群预防血栓的最佳药物，同时将不良出血事件的风险降至最低。方法在图书馆数据库中检索了静脉曲张静脉内消融术后患者接受一种或多种抗凝剂治疗的研究。采用偏倚风险（ROB）评估工具对纳入研究的方法学质量进行量化。研究结果采用流行病学观察性研究荟萃分析（MOOSE）核对表进行报告。使用 metainsight (rpackage) 进行了统计分析。结果分析了不到 1500 例消融术后抗凝治疗（利伐沙班、依诺肝素、磺达肝癸）患者的观察数据。各组患者的特征具有可比性。共发生了 81 起血栓事件和 40 起轻微出血事件。结论该 NMA 表明，对于静脉曲张静脉腔内消融术后患者的血栓预防，预防性利伐沙班是排名最高的抗凝药物，且不良出血风险较低。是否对这些患者进行抗凝治疗可能仍需由临床医生自行决定。

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引用次数: 0

Analysis of Aortic Arch Hemodynamics With Simulated Bird’s Beak Effects 利用模拟鸟嘴效应分析主动脉弓血流动力学

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-04-12 DOI: 10.1177/15385744241247272

Mauricio Gonzalez-Urquijo, Gerardo Alejandro Fumagal González, Héctor Manuel Cárdenas Castro, Arnulfo Alejandro Morales Guzman, Alan Alejandro Guzman Valladares, Danielle Catherine MacDonald, Marcos David Moya Bencomo, Israel Botello Arredondo, Mario Alejandro Fabiani

ObjectiveThe objective of this study was to investigate the flow effects in different degrees of thoracic aortic stent graft protrusion extension by creating bird beak effect simulations using accurate 3D geometry and a realistic, nonlinear, elastic biomechanical model using computer-aided software SolidWorks.MethodsSegmentation in 3D of an aortic arch from a computed tomography (CT) scan of a real-life patient was performed using SolidWorks. A parametric analysis of three models was performed: (A) Aortic arch with no stent, (B) 3 mm bird-beak configuration, and (C) 6.5 mm bird-beak configuration. Flow velocity, pressure, vorticity, wall shear stress (WSS), and time average WSS were assessed.ResultsThe flow velocity in Model A remained relatively constant and low in the area of the ostium of the brachiocephalic artery and doubled in the left subclavian artery. On the contrary, Models B and C showed a decrease in velocity of 52.3 % in the left subclavian artery. Furthermore, Model B showed a drop in velocity of 82.7% below the bird-beak area, whereas Model C showed a decline of 80.9% in this area. The pressure inside the supra-aortic branches was higher in Model B and C compared with Model A. In Model A, vorticity only appeared at the level of the descending aorta, with low to non-vorticity in the aortic arch. In contrast, Models B and C had an average vorticity of 241.4 Hz within the bird beak area. Regarding WSS, Model A, and Model B shared similar WSS in the peak systolic phase, in the aortic arch, and the bird beak area, whereas Model C had an increased WSS by 5 Pa on average at these zones.ConclusionIn the present simulations’ lower velocities, higher pressures, vortices, and WSS were observed around the bird beak zone, the aortic arch, and the supra-aortic vessels.

方法使用 SolidWorks 对真实病人的计算机断层扫描（CT）扫描结果中的主动脉弓进行三维分割。对三个模型进行了参数分析：(A) 无支架的主动脉弓，(B) 3 毫米鸟喙结构，(C) 6.5 毫米鸟喙结构。结果模型 A 的流速在肱动脉骨膜区域保持相对恒定且较低，在左锁骨下动脉则翻倍。相反，模型 B 和 C 显示左锁骨下动脉的流速下降了 52.3%。此外，模型 B 在鸟嘴区以下的速度下降了 82.7%，而模型 C 在这一区域的速度下降了 80.9%。与模型 A 相比，模型 B 和 C 中主动脉上分支内的压力更高。在模型 A 中，涡度只出现在降主动脉水平，主动脉弓内的涡度较低甚至没有涡度。相比之下，模型 B 和 C 在鸟喙区域内的平均涡度为 241.4 赫兹。关于 WSS，模型 A 和模型 B 在收缩期峰值阶段、主动脉弓和鸟嘴区的 WSS 相似，而模型 C 在这些区域的 WSS 平均增加了 5 Pa。

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引用次数: 0

Analysis of Determinants for Suture-mediated Closure Device Failure During EVAR Procedures. EVAR手术中缝线介导的闭合装置失效的决定因素分析。

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-02-01 Epub Date: 2023-07-14 DOI: 10.1177/15385744231189356

W Garabet, A Arnautovic, L Meurer, J Mulorz, J D Rembe, M Duran, J D Süss, H Schelzig, M U Wagenhäuser

Objective: Endovascular aortic repair (EVAR) for elective and emergency infrarenal aortic pathologies is the primary approach for treatment nowadays. During such procedure, the suture-mediated closure device (SMCD) (Perclose ProGlide^TM, Abbott Laboratories, Chicago, IL, USA) is commonly used. This study aimed to identify potential contributors for SMCD failure in a patient cohort of elective and emergency EVAR.

Methods: Archived medical records from patients who underwent EVAR for aortic pathologies in elective and emergency setting at the University Hospital Düsseldorf, Germany were included. Patient's co-morbidities, access vessel morphologies and hemostasis-related blood parameters were evaluated on their association with SMCD failure applying different statistical methods.

Results: A total of 71 patients (139 femoral accesses) was included. The mean age was 73.5 ± 8.4 years. Overall SMCD failure rate was 4.3%, 4.1% for elective and 5.9% for emergency cases, respectively. Total procedure time was longer for the SMCD failure group (323 ± 117.8 min vs 171 ± 43.7 min). The calcification status of the common femoral artery (CFA), the diameter of the aortic bifurcation, and dual anti-platelet therapy (DAPT) on the medication plan prior to the procedure were associated with SMCD failure. Univariate binary logistic regression analysis nominated several potentially relevant predictors for SMCD failure who underwent subsequent multivariable binary logistic regression analysis. Here, DAPT on the medication plan was identified as being promising in predicting SMCD failure (OR 30.5), while anterior plaque formation in the CFA maintained as only statistically relevant determinant (OR 44.9).

Conclusions: This study confirms the CFA calcification status to be associated with SMCD failure. Although discontinued prior to endovascular treatment, DAPT was also found to be associated with SMCD failure. Our results may advocate to perform obligatory platelet testing prior to EVAR to maximize patient safety.

目的：血管内主动脉修补术（EVAR）是目前治疗择期和急诊肾下主动脉病变的主要方法。在此类手术中，通常使用缝合器（SMCD）（Perclose ProGlideTM，Abbott Laboratories，Chicago，IL，USA）。本研究旨在确定择期和急诊 EVAR 患者队列中导致 SMCD 失效的潜在因素：方法：纳入德国杜塞尔多夫大学医院因主动脉病变在择期和急诊情况下接受 EVAR 的患者的存档病历。采用不同的统计方法评估了患者的合并疾病、入路血管形态和止血相关血液参数与 SMCD 失败的关系：结果：共纳入 71 名患者（139 条股动脉通路）。平均年龄为 73.5 ± 8.4 岁。SMCD总失败率为4.3%，择期手术失败率为4.1%，急诊手术失败率为5.9%。SMCD失败组的手术总时间更长（323±117.8分钟 vs 171±43.7分钟）。股总动脉（CFA）的钙化状态、主动脉分叉的直径以及术前用药计划中的双联抗血小板疗法（DAPT）与SMCD失败有关。单变量二元逻辑回归分析发现了几个可能与 SMCD 失败有关的预测因素，并对其进行了多变量二元逻辑回归分析。其中，药物治疗计划中的DAPT被认为有望预测SMCD失败（OR 30.5），而CFA前斑块形成仍是唯一具有统计学意义的决定因素（OR 44.9）：本研究证实，CFA钙化状态与SMCD失败有关。虽然在血管内治疗前停止了 DAPT，但也发现 DAPT 与 SMCD 失败有关。我们的研究结果可能倡导在 EVAR 前进行强制性血小板检测，以最大限度地保障患者安全。

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引用次数: 0

Quality and Readability of Spanish-Language Online Information for Aortic Aneurysm and Its Endovascular Treatment. 主动脉瘤及其血管内治疗西班牙语在线信息的质量和可读性。

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery

Pub Date : 2024-02-01 Epub Date: 2023-08-18 DOI: 10.1177/15385744231196644

Enrique M San Norberto, Álvaro Revilla, José A Brizuela, James H Taylor

Background: Aortic aneurysms represent a chronic degenerative disease with life-threatening implications. In order for patients to comprehend health related information, it must be written at a level that can be readily understood.

Study design: In January 2023, we searched "aneurisma aorta" and "endoprótesis aorta" terms on Google, Yahoo and Microsoft/Bing. The 31th websites provided by each search engine were analyzed. Four readability measures were used to evaluate websites regarding aortic aneurysm and their endovascular treatment in Spanish language: Flesch Index, Flesch-Szigriszt Index, Fernández-Huerta Index and grading Inflesz scale. The quality on information was evaluated by the HONcode seal, the DISCERN instrument and the JAMA benchmark criteria.

Results: 180 websites containing the terms "aneurisma aorta" and "endoprótesis aorta" were analyzed. Among the websites retrieved, the mean Flesh index score (53.12 ± 6.09 and 47.48 ± 7.12, respectively; P = .019), the Flesch-Szigriszt index (56.39 ± 5.72 and 48.10 ± 8.33; P = .000), and the Fernández Huerta index (61.30 ± 5.59 and 53.19 ± 8.21; P = .000), corresponding to a "somewhat difficult" readability level. In addition, the Inflesz scale (2.62 ± .59 and 2.07 ± .61; P = .000) reported a "somewhat difficult" readability, higher for the websites regarding aortic aneurysm. The HONcode seal was only presented in websites regarding aortic aneurysm (16.7%), whereas none of the websites relating to aortic endoprostheses presented it (0%) (P = .000). Websites that presented the HONcode seal obtained higher DISCERN score (P = .000, 95% CI = 6.42-16.84) and JAMA score (P = .000, 95% CI = 3.44-11.32).

Conclusion: Internet information on aortic aneurysms and aortic endoprostheses is too difficult to read for the general Spanish-speaking population and is lacking in quality.

背景：主动脉瘤是一种慢性退行性疾病，会危及生命。为了让患者理解与健康相关的信息，必须以易于理解的方式编写：2023 年 1 月，我们在谷歌、雅虎和微软/Bing 上搜索 "主动脉瘤 "和 "主动脉内膜剥脱术"。我们对每个搜索引擎提供的第 31 个网站进行了分析。在评估西班牙文主动脉瘤及其血管内治疗相关网站时，使用了四种可读性测量方法：Flesch指数、Flesch-Szigriszt指数、Fernández-Huerta指数和Inflesz分级表。信息质量通过 HONcode seal、DISCERN instrument 和 JAMA 基准标准进行评估：结果：分析了 180 个包含 "主动脉瘤 "和 "主动脉内膜剥脱术 "的网站。在检索到的网站中，Flesh 指数平均得分（分别为 53.12 ± 6.09 和 47.48 ± 7.12；P = .019）、Flesch-Szigriszt 指数（分别为 56.39 ± 5.72 和 48.10 ± 8.33；P = .000）和 Fernández Huerta 指数（分别为 61.30 ± 5.59 和 53.19 ± 8.21；P = .000），相当于 "有点难 "的可读性级别。此外，Inflesz 量表（2.62 ± 0.59 和 2.07 ± 0.61；P = 0.000）显示，主动脉瘤相关网站的可读性为 "略难"。只有主动脉瘤相关网站（16.7%）显示了HONcode标识，而主动脉内膜假体相关网站均未显示（0%）（P = .000）。显示 HONcode 印章的网站获得了更高的 DISCERN 分数（P = .000, 95% CI = 6.42-16.84）和 JAMA 分数（P = .000, 95% CI = 3.44-11.32）：结论：关于主动脉瘤和主动脉内膜的互联网信息对于一般西班牙语人群来说太难阅读，而且质量不高。

{"title":"Quality and Readability of Spanish-Language Online Information for Aortic Aneurysm and Its Endovascular Treatment.","authors":"Enrique M San Norberto, Álvaro Revilla, José A Brizuela, James H Taylor","doi":"10.1177/15385744231196644","DOIUrl":"10.1177/15385744231196644","url":null,"abstract":"Background: Aortic aneurysms represent a chronic degenerative disease with life-threatening implications. In order for patients to comprehend health related information, it must be written at a level that can be readily understood.Study design: In January 2023, we searched \"aneurisma aorta\" and \"endoprótesis aorta\" terms on Google, Yahoo and Microsoft/Bing. The 31th websites provided by each search engine were analyzed. Four readability measures were used to evaluate websites regarding aortic aneurysm and their endovascular treatment in Spanish language: Flesch Index, Flesch-Szigriszt Index, Fernández-Huerta Index and grading Inflesz scale. The quality on information was evaluated by the HONcode seal, the DISCERN instrument and the JAMA benchmark criteria.Results: 180 websites containing the terms \"aneurisma aorta\" and \"endoprótesis aorta\" were analyzed. Among the websites retrieved, the mean Flesh index score (53.12 ± 6.09 and 47.48 ± 7.12, respectively; P = .019), the Flesch-Szigriszt index (56.39 ± 5.72 and 48.10 ± 8.33; P = .000), and the Fernández Huerta index (61.30 ± 5.59 and 53.19 ± 8.21; P = .000), corresponding to a \"somewhat difficult\" readability level. In addition, the Inflesz scale (2.62 ± .59 and 2.07 ± .61; P = .000) reported a \"somewhat difficult\" readability, higher for the websites regarding aortic aneurysm. The HONcode seal was only presented in websites regarding aortic aneurysm (16.7%), whereas none of the websites relating to aortic endoprostheses presented it (0%) (P = .000). Websites that presented the HONcode seal obtained higher DISCERN score (P = .000, 95% CI = 6.42-16.84) and JAMA score (P = .000, 95% CI = 3.44-11.32).Conclusion: Internet information on aortic aneurysms and aortic endoprostheses is too difficult to read for the general Spanish-speaking population and is lacking in quality.","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":" ","pages":"158-165"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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