Pub Date : 2024-02-01Epub Date: 2023-08-22DOI: 10.1177/15385744231197457
Shi Lu Zhao, Jian Ping Xiong, Jing Yuan Luan, Zi Chang Jia, Jin Tao Han, Qi Chen Feng, Jin Man Zhuang, Tian Run Li, Chang Ming Wang, Xuan Li
Purpose: To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR).
Materials and methods: 224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality.
Results: The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively (P < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm3 to 202.6 ± 114.1 cm3, 155.6 ± 68.4 cm3 and 129.7 ± 52.4 cm3 (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively (P < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research.
Conclusions: Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac.
{"title":"Intra-Sac Injection of Thrombin During Endovascular Aneurysm Repair to Remedy Type II Endoleak and Promote Sac Shrinkage.","authors":"Shi Lu Zhao, Jian Ping Xiong, Jing Yuan Luan, Zi Chang Jia, Jin Tao Han, Qi Chen Feng, Jin Man Zhuang, Tian Run Li, Chang Ming Wang, Xuan Li","doi":"10.1177/15385744231197457","DOIUrl":"10.1177/15385744231197457","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR).</p><p><strong>Materials and methods: </strong>224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality.</p><p><strong>Results: </strong>The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively (<i>P</i> < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm<sup>3</sup> to 202.6 ± 114.1 cm<sup>3</sup>, 155.6 ± 68.4 cm<sup>3</sup> and 129.7 ± 52.4 cm<sup>3</sup> (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively (<i>P</i> < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research.</p><p><strong>Conclusions: </strong>Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10048207","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}
Pub Date : 2024-02-01Epub Date: 2023-07-20DOI: 10.1177/15385744231191216
Sukgu M Han, Alexander D DiBartolomeo, Alyssa J Pyun, Shelley Maithel, Sanjeet Patel, Fernando Fleischman
A 70-year-old male with a history of 3 prior median sternotomies and on anticoagulation presented with acute chest and back pain associated with a pseudoaneurysm of the ascending and aortic arch in the setting of residual dissection involving the innominate, proximal right carotid, and subclavian arteries. A physician-modified triple vessel fenestrated-branched arch endograft was deployed. The innominate branch stent was deployed from the right carotid cut down, while the left carotid and left subclavian branch stents were placed from a femoral approach. Postoperatively, the innominate branch was found to be deployed in the false lumen of the dissected native innominate artery, leading to continued pressurization of the pseudoaneurysm. This was rescued by placing a Gore Iliac Branch Endoprosthesis (IBE) into the innominate branch through a temporary conduit sewn to the right carotid artery with a right subclavian branch placed via a brachial artery cut down into the internal iliac gate. The use of IBE allowed branch stent extension past the dissected native vessels. The patient had an uneventful recovery without neurologic complications. At 3-month follow-up, the patient remains well with an excluded pseudoaneurysm, and patent bifurcated innominate, bilateral carotid, and subclavian artery branches. A Gore IBE can be utilized in a dissected innominate artery to create an innominate branch device during fenestrated-branched endovascular arch repair.
{"title":"Use of Iliac Branch Endoprosthesis to Rescue Inadvertent False Lumen Deployment of the Innominate Branch Stent During Physician-Modified Fenestrated-Branched Aortic Arch Repair.","authors":"Sukgu M Han, Alexander D DiBartolomeo, Alyssa J Pyun, Shelley Maithel, Sanjeet Patel, Fernando Fleischman","doi":"10.1177/15385744231191216","DOIUrl":"10.1177/15385744231191216","url":null,"abstract":"<p><p>A 70-year-old male with a history of 3 prior median sternotomies and on anticoagulation presented with acute chest and back pain associated with a pseudoaneurysm of the ascending and aortic arch in the setting of residual dissection involving the innominate, proximal right carotid, and subclavian arteries. A physician-modified triple vessel fenestrated-branched arch endograft was deployed. The innominate branch stent was deployed from the right carotid cut down, while the left carotid and left subclavian branch stents were placed from a femoral approach. Postoperatively, the innominate branch was found to be deployed in the false lumen of the dissected native innominate artery, leading to continued pressurization of the pseudoaneurysm. This was rescued by placing a Gore Iliac Branch Endoprosthesis (IBE) into the innominate branch through a temporary conduit sewn to the right carotid artery with a right subclavian branch placed via a brachial artery cut down into the internal iliac gate. The use of IBE allowed branch stent extension past the dissected native vessels. The patient had an uneventful recovery without neurologic complications. At 3-month follow-up, the patient remains well with an excluded pseudoaneurysm, and patent bifurcated innominate, bilateral carotid, and subclavian artery branches. A Gore IBE can be utilized in a dissected innominate artery to create an innominate branch device during fenestrated-branched endovascular arch repair.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9848908","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}
Background: Fibromuscular dysplasia is an idiopathic, segmental, nonatherosclerotic, noninflammatory vascular disease that can lead to arterial stenosis, tortuosity, occlusion, aneurysms, and dissection. Fibromuscular dysplasia is a rare cause of hypertension that can easily be missed. To date, there has been no definitive treatment for fibromuscular dysplasia.
Case report: In this report, we present an uncommon case of renovascular hypertension in a 21-year-old non-white female with a 3-year history of hypertension secondary to fibromuscular dysplasia involving bilateral renal arteries. Computed tomography angiography during the arterial phase revealed distal focal narrowing of the right main renal artery, distal focal narrowing of the left main renal artery, and proximal focal narrowing of the left accessory lower renal artery. Percutaneous balloon dilatation of the stenotic lesion was performed successfully up to 1 year After the procedure, the arterial blood pressure was within the normal range (110/70 to 125/75 mmHg) without medication. After 1 year of follow-up, CTA revealed re-stenosis in left main renal artery without clinical symptoms and normal blood pressure. Repeated procedure was done successfully.
Conclusions: This case report highlights the difficulty in the diagnosis and treatment of focal fibromuscular dysplasia in young non-white female patients. Computerized tomographic angiography is a useful tool for identifying the cause and showing the benefit of percutaneous transluminal renal angioplasty treatment for this rare entity, as an early percutaneous angioplasty intervention may have a clinical cure for hypertension.
{"title":"A Rare Case of Focal Renal Fibromuscular Dysplasia Treated With Angioplasty: A Case Report.","authors":"Abdulqader Al-Falahi, Ghamdan Al-Aghbari, Maher Al-Muriesh","doi":"10.1177/15385744231196627","DOIUrl":"10.1177/15385744231196627","url":null,"abstract":"<p><strong>Background: </strong>Fibromuscular dysplasia is an idiopathic, segmental, nonatherosclerotic, noninflammatory vascular disease that can lead to arterial stenosis, tortuosity, occlusion, aneurysms, and dissection. Fibromuscular dysplasia is a rare cause of hypertension that can easily be missed. To date, there has been no definitive treatment for fibromuscular dysplasia.</p><p><strong>Case report: </strong>In this report, we present an uncommon case of renovascular hypertension in a 21-year-old non-white female with a 3-year history of hypertension secondary to fibromuscular dysplasia involving bilateral renal arteries. Computed tomography angiography during the arterial phase revealed distal focal narrowing of the right main renal artery, distal focal narrowing of the left main renal artery, and proximal focal narrowing of the left accessory lower renal artery. Percutaneous balloon dilatation of the stenotic lesion was performed successfully up to 1 year After the procedure, the arterial blood pressure was within the normal range (110/70 to 125/75 mmHg) without medication. After 1 year of follow-up, CTA revealed re-stenosis in left main renal artery without clinical symptoms and normal blood pressure. Repeated procedure was done successfully.</p><p><strong>Conclusions: </strong>This case report highlights the difficulty in the diagnosis and treatment of focal fibromuscular dysplasia in young non-white female patients. Computerized tomographic angiography is a useful tool for identifying the cause and showing the benefit of percutaneous transluminal renal angioplasty treatment for this rare entity, as an early percutaneous angioplasty intervention may have a clinical cure for hypertension.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10014562","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}
Pub Date : 2024-02-01Epub Date: 2023-08-23DOI: 10.1177/15385744231198363
Sabine Sieber, Albert Busch, Mine Sargut, Christoph Knappich, Bianca Bohmann, Angelos Karlas, Helmut Friess, Hans-Henning Eckstein, Alexander Novotny
Objectives: Secondary aortoenteric fistula is a rare and life-threatening condition. Clear evidence on the ideal therapeutic approach is largely missing. This study aims to analyze symptoms, etiology, risk factors, and outcomes based on procedural details.
Patients and methods: All patients with secondary aortoenteric fistula admitted between 2003 and 2021 were included. Patient characteristics, surgical procedure details, and postoperative outcomes were analyzed. Outcomes were stratified and compared according to the urgency of operation and the procedure performed. Descriptive statistics were used. The primary endpoint was in-hospital mortality.
Results: A total of twentytwo patients (68% male, median age 70 years) were identified. Main symptoms were gastrointestinal bleeding, pain, and fever. From the twentytwo patients ten patients required emergency surgery and ten urgent surgery. Emergency patients were older on average (74 vs 63 years, P = .015) and had a higher risk of postoperative respiratory complications (80% vs 10%, P = .005). Primary open surgery with direct replacement of the aorta or an extra-anatomic bypass with an additional direct suture or resection of the involved bowel was performed in sixteen patients. In four patients underwent endovascular bridging treatment with the definitive approach as a second step. Other two patients died without operation (1x refusal; 1x palliative cancer history). In-hospital mortality was 27%, respectively. Compared to patients undergoing urgent surgery, those treated emergently showed significantly higher in-hospital (50% vs 0%, P = .0033) mortalities.
Conclusion: Despite rapid diagnosis and treatment, secondary aortoenteric fistula remains a life-threatening condition with 27% in-hospital mortality, significantly increased upon emergency presentation.
{"title":"A Modern Series of Secondary Aortoenteric Fistula - A 19-Year Experience.","authors":"Sabine Sieber, Albert Busch, Mine Sargut, Christoph Knappich, Bianca Bohmann, Angelos Karlas, Helmut Friess, Hans-Henning Eckstein, Alexander Novotny","doi":"10.1177/15385744231198363","DOIUrl":"10.1177/15385744231198363","url":null,"abstract":"<p><strong>Objectives: </strong>Secondary aortoenteric fistula is a rare and life-threatening condition. Clear evidence on the ideal therapeutic approach is largely missing. This study aims to analyze symptoms, etiology, risk factors, and outcomes based on procedural details.</p><p><strong>Patients and methods: </strong>All patients with secondary aortoenteric fistula admitted between 2003 and 2021 were included. Patient characteristics, surgical procedure details, and postoperative outcomes were analyzed. Outcomes were stratified and compared according to the urgency of operation and the procedure performed. Descriptive statistics were used. The primary endpoint was in-hospital mortality.</p><p><strong>Results: </strong>A total of twentytwo patients (68% male, median age 70 years) were identified. Main symptoms were gastrointestinal bleeding, pain, and fever. From the twentytwo patients ten patients required emergency surgery and ten urgent surgery. Emergency patients were older on average (74 vs 63 years, <i>P</i> = .015) and had a higher risk of postoperative respiratory complications (80% vs 10%, <i>P</i> = .005). Primary open surgery with direct replacement of the aorta or an extra-anatomic bypass with an additional direct suture or resection of the involved bowel was performed in sixteen patients. In four patients underwent endovascular bridging treatment with the definitive approach as a second step. Other two patients died without operation (1x refusal; 1x palliative cancer history). In-hospital mortality was 27%, respectively. Compared to patients undergoing urgent surgery, those treated emergently showed significantly higher in-hospital (50% vs 0%, <i>P</i> = .0033) mortalities.</p><p><strong>Conclusion: </strong>Despite rapid diagnosis and treatment, secondary aortoenteric fistula remains a life-threatening condition with 27% in-hospital mortality, significantly increased upon emergency presentation.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054221","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}
Pub Date : 2024-02-01Epub Date: 2023-08-27DOI: 10.1177/15385744231198934
Sean Hamlin, Stephen R Gallo, Jameson Petrochko, Jacob Wilson, Sharvil Sheth
Purpose: To highlight median arcuate ligament syndrome as a potential cause for celiac artery stenosis and pancreaticoduodenal artery aneurysm, and describe treatment options in this setting.
Case report: A 63-year-old male presented with a pancreaticoduodenal artery aneurysm and concomitant celiac artery stenosis that was treated with celiac artery stenting and aneurysm coiling. He subsequently developed stent fracture and celiac artery occlusion secondary to previously unrecognized median arcuate ligament syndrome causing reperfusion of the aneurysm. This was treated with open median arcuate ligament release and aorta to common hepatic artery bypass with good clinical result and stable 20-month surveillance imaging.
Conclusion: It is critical to recognize median arcuate ligament syndrome as a cause of celiac artery stenosis in the setting of pancreaticoduodenal artery aneurysm given the high risk of failure of endovascular stenting. Open aorto-hepatic artery bypass and endovascular aneurysm coiling should be the preferred approach in these patients.
{"title":"Pancreaticoduodenal Artery Aneurysm Complicated by Median Arcuate Ligament Syndrome.","authors":"Sean Hamlin, Stephen R Gallo, Jameson Petrochko, Jacob Wilson, Sharvil Sheth","doi":"10.1177/15385744231198934","DOIUrl":"10.1177/15385744231198934","url":null,"abstract":"<p><strong>Purpose: </strong>To highlight median arcuate ligament syndrome as a potential cause for celiac artery stenosis and pancreaticoduodenal artery aneurysm, and describe treatment options in this setting.</p><p><strong>Case report: </strong>A 63-year-old male presented with a pancreaticoduodenal artery aneurysm and concomitant celiac artery stenosis that was treated with celiac artery stenting and aneurysm coiling. He subsequently developed stent fracture and celiac artery occlusion secondary to previously unrecognized median arcuate ligament syndrome causing reperfusion of the aneurysm. This was treated with open median arcuate ligament release and aorta to common hepatic artery bypass with good clinical result and stable 20-month surveillance imaging.</p><p><strong>Conclusion: </strong>It is critical to recognize median arcuate ligament syndrome as a cause of celiac artery stenosis in the setting of pancreaticoduodenal artery aneurysm given the high risk of failure of endovascular stenting. Open aorto-hepatic artery bypass and endovascular aneurysm coiling should be the preferred approach in these patients.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10084451","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}
Pub Date : 2024-02-01Epub Date: 2023-08-28DOI: 10.1177/15385744231198715
Alexandra Catasta, Antonio Freyrie, Alberto Bramucci, Claudio Bianchini Massoni, Paolo Perini
Spinal cord ischemia leading to paraplegia is a rare, life-limiting complication of acute type B aortic dissection. We report a case of spinal cord ischemia occurred in a young woman treated with endovascular scissor technique in urgent setting. The patient had an uneventful post-procedural course. After 4 months, computed tomography angiography confirmed false lumen reperfusion and major symptoms were regressed. In selected cases, this procedure is a tool to improve false lumen perfusion in type B dissections, and demonstrated to be helpful in our case of spinal cord ischaemia.
脊髓缺血导致截瘫是急性 B 型主动脉夹层的一种罕见并危及生命的并发症。我们报告了一例在紧急情况下使用血管内剪刀技术治疗的年轻女性脊髓缺血病例。患者术后恢复顺利。4 个月后,计算机断层扫描血管造影证实了假腔再灌注,主要症状也得到缓解。在选定的病例中,这种手术是改善B型血管断裂假腔灌注的一种工具,在我们的脊髓缺血病例中也得到了证实。
{"title":"Acute Type B Aortic Dissection Complicated With Spinal Cord Ischemia and Paraplegia Treated With Endovascular Scissor Technique.","authors":"Alexandra Catasta, Antonio Freyrie, Alberto Bramucci, Claudio Bianchini Massoni, Paolo Perini","doi":"10.1177/15385744231198715","DOIUrl":"10.1177/15385744231198715","url":null,"abstract":"<p><p>Spinal cord ischemia leading to paraplegia is a rare, life-limiting complication of acute type B aortic dissection. We report a case of spinal cord ischemia occurred in a young woman treated with endovascular scissor technique in urgent setting. The patient had an uneventful post-procedural course. After 4 months, computed tomography angiography confirmed false lumen reperfusion and major symptoms were regressed. In selected cases, this procedure is a tool to improve false lumen perfusion in type B dissections, and demonstrated to be helpful in our case of spinal cord ischaemia.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10166603","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}
Pub Date : 2024-02-01Epub Date: 2023-07-10DOI: 10.1177/15385744231189021
Charles Risbey, Oleksandr Khoma, Joo-Shik Shin, Charbel Sandroussi
There is a paucity of research investigating revision surgery for patients with previous inferior vena cava (IVC) reconstruction using bovine pericardium (BP). To the best of our knowledge, no reports of redo procedures have been published in the medical literature. We describe two cases of redo surgery in patients with previous IVC reconstructions using BP following disease recurrence. The first case underwent resection of the BP graft with a second IVC reconstruction using BP, the second case underwent resection of the BP graft without reconstruction due to extensive thromboses. Neither case experienced perioperative complication or morbidity following their redo procedure, and previous IVC reconstruction with BP did not present significant intraoperative technical challenges. One case showed evidence of endothelialisation of the excised BP graft, however, it was not possible to definitively conclude if endothelialisation was present in the second case. Overall, these cases demonstrate that previous IVC reconstruction using BP should not be considered an absolute contraindication for redo surgery in the context of disease recurrence.
对于曾使用牛心包(BP)重建下腔静脉(IVC)的患者进行翻修手术的研究很少。据我们所知,医学文献中还没有关于重做手术的报道。我们介绍了两例曾使用 BP 重建 IVC 的患者在疾病复发后重新进行手术的病例。第一个病例切除了BP移植物,并使用BP进行了第二次IVC重建;第二个病例由于广泛血栓形成,切除了BP移植物,但没有进行重建。两例患者在重做手术后都没有出现围手术期并发症或发病率,之前使用 BP 重建的 IVC 在术中也没有遇到重大的技术挑战。一个病例显示切除的 BP 移植体有内皮化的迹象,但第二个病例无法明确断定是否存在内皮化。总之,这些病例表明,在疾病复发的情况下,先前使用 BP 重建 IVC 不应被视为重做手术的绝对禁忌症。
{"title":"Revision Surgery is Possible in Patients With Previous Bovine Pericardium Inferior Vena Cava Reconstruction: A Case Series and Review of Literature.","authors":"Charles Risbey, Oleksandr Khoma, Joo-Shik Shin, Charbel Sandroussi","doi":"10.1177/15385744231189021","DOIUrl":"10.1177/15385744231189021","url":null,"abstract":"<p><p>There is a paucity of research investigating revision surgery for patients with previous inferior vena cava (IVC) reconstruction using bovine pericardium (BP). To the best of our knowledge, no reports of redo procedures have been published in the medical literature. We describe two cases of redo surgery in patients with previous IVC reconstructions using BP following disease recurrence. The first case underwent resection of the BP graft with a second IVC reconstruction using BP, the second case underwent resection of the BP graft without reconstruction due to extensive thromboses. Neither case experienced perioperative complication or morbidity following their redo procedure, and previous IVC reconstruction with BP did not present significant intraoperative technical challenges. One case showed evidence of endothelialisation of the excised BP graft, however, it was not possible to definitively conclude if endothelialisation was present in the second case. Overall, these cases demonstrate that previous IVC reconstruction using BP should not be considered an absolute contraindication for redo surgery in the context of disease recurrence.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9923623","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}
Pub Date : 2024-02-01Epub Date: 2023-08-24DOI: 10.1177/15385744231197097
Mirte Langeveld, Romy Bosman, Caroline A Hundepool, Liron S Duraku, Christopher McGhee, J Michiel Zuidam, Tom Barker, Maciej Juszczak, Dominic M Power
Background: Phantom limb pain (PLP) and symptomatic neuroma can be debilitating and significantly impact the quality of life of amputees. However, the prevalence of PLP and symptomatic neuromas in patients following dysvascular lower limb amputation (LLA) has not been reliably established. This systematic review and meta-analysis evaluates the prevalence and incidence of phantom limb pain and symptomatic neuroma after dysvascular LLA.
Methods: Four databases (Embase, MEDLINE, Cochrane Central, and Web of Science) were searched on October 5th, 2022. Prospective or retrospective observational cohort studies or cross-sectional studies reporting either the prevalence or incidence of phantom limb pain and/or symptomatic neuroma following dysvascular LLA were identified. Two reviewers independently conducted the screening, data extraction, and the risk of bias assessment according to the PRISMA guidelines. To estimate the prevalence of phantom limb pain, a meta-analysis using a random effects model was performed.
Results: Twelve articles were included in the quantitative analysis, including 1924 amputees. A meta-analysis demonstrated that 69% of patients after dysvascular LLA experience phantom limb pain (95% CI 53-86%). The reported pain intensity on a scale from 0-10 in LLA patients ranged between 2.3 ± 1.4 and 5.5 ± .7. A single study reported an incidence of symptomatic neuroma following dysvascular LLA of 5%.
Conclusions: This meta-analysis demonstrates the high prevalence of phantom limb pain after dysvascular LLA. Given the often prolonged and disabling nature of neuropathic pain and the difficulties managing it, more consideration needs to be given to strategies to prevent it at the time of amputation.
{"title":"Phantom Limb Pain and Painful Neuroma After Dysvascular Lower-Extremity Amputation: A Systematic Review and Meta-Analysis.","authors":"Mirte Langeveld, Romy Bosman, Caroline A Hundepool, Liron S Duraku, Christopher McGhee, J Michiel Zuidam, Tom Barker, Maciej Juszczak, Dominic M Power","doi":"10.1177/15385744231197097","DOIUrl":"10.1177/15385744231197097","url":null,"abstract":"<p><strong>Background: </strong>Phantom limb pain (PLP) and symptomatic neuroma can be debilitating and significantly impact the quality of life of amputees. However, the prevalence of PLP and symptomatic neuromas in patients following dysvascular lower limb amputation (LLA) has not been reliably established. This systematic review and meta-analysis evaluates the prevalence and incidence of phantom limb pain and symptomatic neuroma after dysvascular LLA.</p><p><strong>Methods: </strong>Four databases (Embase, MEDLINE, Cochrane Central, and Web of Science) were searched on October 5<sup>th</sup>, 2022. Prospective or retrospective observational cohort studies or cross-sectional studies reporting either the prevalence or incidence of phantom limb pain and/or symptomatic neuroma following dysvascular LLA were identified. Two reviewers independently conducted the screening, data extraction, and the risk of bias assessment according to the PRISMA guidelines. To estimate the prevalence of phantom limb pain, a meta-analysis using a random effects model was performed.</p><p><strong>Results: </strong>Twelve articles were included in the quantitative analysis, including 1924 amputees. A meta-analysis demonstrated that 69% of patients after dysvascular LLA experience phantom limb pain (95% CI 53-86%). The reported pain intensity on a scale from 0-10 in LLA patients ranged between 2.3 ± 1.4 and 5.5 ± .7. A single study reported an incidence of symptomatic neuroma following dysvascular LLA of 5%.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates the high prevalence of phantom limb pain after dysvascular LLA. Given the often prolonged and disabling nature of neuropathic pain and the difficulties managing it, more consideration needs to be given to strategies to prevent it at the time of amputation.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10443139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2023-08-02DOI: 10.1177/15385744231190448
Bernardo Kremer Diniz, Marcello Sena, Paulo Henrique Lima
Purpose: We report the case of an acute type B dissection with high-risk features treated with multilayer stent.
Case report: A 50-year-old female patient presented to the emergency department with an acute type B aortic dissection. Conservative medical treatment did control blood pressure but did not alleviate her dissection symptoms. She was treated endovascularly with multilayer stents extensively covering the whole dissected area. HThe aortic arch side branches, visceral arteries and renal arteries remained patent after treatment. The recovery was uneventful, and she was discharged the day after the intervention. At 6- and 12-month follow-up, the patient remained asymptomatic, the true lumen volume increased and all side branches remained patent.
Conclusion: We present a case of the use of a multilayer stent for acute type B aortic dissection. This technique allows to treat the whole dissection with low risk of paraplegia or side branch occlusion. Long-term results of ongoing clinical studies should confirm the place of the multilayer stent as a treatment option for type B aortic dissection.
目的:我们报告了一例使用多层支架治疗具有高风险特征的急性 B 型主动脉夹层的病例:一名 50 岁的女性患者因急性 B 型主动脉夹层来到急诊科就诊。保守治疗控制了血压,但并未缓解夹层症状。她接受了血管内治疗,多层支架广泛覆盖了整个夹层区域。治疗后,主动脉弓侧支、内脏动脉和肾动脉保持通畅。术后恢复顺利,术后第二天就出院了。在 6 个月和 12 个月的随访中,患者仍无症状,真腔容积增加,所有侧支保持通畅:我们介绍了一例使用多层支架治疗急性 B 型主动脉夹层的病例。结论:我们展示了一例使用多层支架治疗急性 B 型主动脉夹层的病例,这种技术可以治疗整个夹层,而且发生截瘫或侧枝闭塞的风险较低。正在进行的临床研究的长期结果将证实多层支架作为治疗 B 型主动脉夹层的一种选择。
{"title":"Multilayer Stent for Emergency Treatment of Acute Type B Aortic Dissection: A Case Report.","authors":"Bernardo Kremer Diniz, Marcello Sena, Paulo Henrique Lima","doi":"10.1177/15385744231190448","DOIUrl":"10.1177/15385744231190448","url":null,"abstract":"<p><strong>Purpose: </strong>We report the case of an acute type B dissection with high-risk features treated with multilayer stent.</p><p><strong>Case report: </strong>A 50-year-old female patient presented to the emergency department with an acute type B aortic dissection. Conservative medical treatment did control blood pressure but did not alleviate her dissection symptoms. She was treated endovascularly with multilayer stents extensively covering the whole dissected area. HThe aortic arch side branches, visceral arteries and renal arteries remained patent after treatment. The recovery was uneventful, and she was discharged the day after the intervention. At 6- and 12-month follow-up, the patient remained asymptomatic, the true lumen volume increased and all side branches remained patent.</p><p><strong>Conclusion: </strong>We present a case of the use of a multilayer stent for acute type B aortic dissection. This technique allows to treat the whole dissection with low risk of paraplegia or side branch occlusion. Long-term results of ongoing clinical studies should confirm the place of the multilayer stent as a treatment option for type B aortic dissection.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9911364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Lower limb venous anomalies, including duplicated veins, are common and have significant impacts on the outcomes and efficacy of venous surgery. Digital subtraction angiography (DSA) guided venography, serving as the tertiary diagnostic option for venous disorders, offers valuable informations to clinical practitioners.
Patients and methods: A retrospective study was conducted on 195 patients with suspected venous disease, evaluating 259 limbs with venography imaging. Two experienced interventional vascularists evaluated the images to determine the incidence and characteristics of variances in the femoral, popliteal, great saphenous, and small saphenous veins. Moreover, blood samples were collected to assess the safety of the venography procedure by monitoring changes in renal function.
Result: Duplication variations were found in the lower limb veins, with the highest prevalence in the femoral vein (11.28%, 22/195), followed by the great saphenous vein (4.1%, 8/195), and the popliteal vein (1.54%, 3/195). No severe contrast agent allergies or postoperative complications were reported. No statistically significant differences were found in creatinine and urea levels pre- and post-operation for patients without duplication variations, those with duplication of the great saphenous, femoral, or popliteal vein (P < .05).
Conclusion: DSA-guided venography is effective in identifying venous variations in lower limb disease. DFV is the most common recurrent vein, while DPV is the least. Adequate preparation ensures safety, high spatial resolution, dynamic imaging, and low tissue interference.
{"title":"Diagnostic Value of Lower Extremity Venous Duplication via Digital Subtraction Angiography Guided Venography.","authors":"Ming Tang, Weijian Fan, Jianwei Cui, Qingling Liu, Xindong Chang, Mingfei He, Qingqing Fang, Siyuan Wang, Mianpeng Chen, Shiwu Yin","doi":"10.1177/15385744231198355","DOIUrl":"10.1177/15385744231198355","url":null,"abstract":"<p><strong>Introduction: </strong>Lower limb venous anomalies, including duplicated veins, are common and have significant impacts on the outcomes and efficacy of venous surgery. Digital subtraction angiography (DSA) guided venography, serving as the tertiary diagnostic option for venous disorders, offers valuable informations to clinical practitioners.</p><p><strong>Patients and methods: </strong>A retrospective study was conducted on 195 patients with suspected venous disease, evaluating 259 limbs with venography imaging. Two experienced interventional vascularists evaluated the images to determine the incidence and characteristics of variances in the femoral, popliteal, great saphenous, and small saphenous veins. Moreover, blood samples were collected to assess the safety of the venography procedure by monitoring changes in renal function.</p><p><strong>Result: </strong>Duplication variations were found in the lower limb veins, with the highest prevalence in the femoral vein (11.28%, 22/195), followed by the great saphenous vein (4.1%, 8/195), and the popliteal vein (1.54%, 3/195). No severe contrast agent allergies or postoperative complications were reported. No statistically significant differences were found in creatinine and urea levels pre- and post-operation for patients without duplication variations, those with duplication of the great saphenous, femoral, or popliteal vein (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>DSA-guided venography is effective in identifying venous variations in lower limb disease. DFV is the most common recurrent vein, while DPV is the least. Adequate preparation ensures safety, high spatial resolution, dynamic imaging, and low tissue interference.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10041919","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}