Pub Date : 2024-02-01Epub Date: 2023-08-30DOI: 10.1177/15385744231198944
Chung Yan Vernon Lee, Ibrahim Natalwala, Nasim Tahir, Robert D Bains
An otherwise healthy 9-month-old infant was treated for a true aneurysm of the proximal brachial artery. The swelling was first noted at seven months of age. An ultrasound scan showed a 2 cm × 2 cm aneurysm of the left brachial artery at the level of the mid-upper arm. Whole-body magnetic resonance angiography (MRA) confirmed this was a true aneurysm of the brachial artery; there was good distal runoff and no other aneurysms elsewhere. Vasculitis screen was negative. Surgical excision of the aneurysm and reconstruction of the brachial artery was performed with a reversed cephalic vein graft. The patient made an uneventful recovery and was discharged home. We present an overview of the workup report and emphasise that a multi-disciplinary team approach is imperative for assessing and managing this rare condition.
{"title":"A Rare Case of Brachial Artery Aneurysm in a 9-Month-Old Infant.","authors":"Chung Yan Vernon Lee, Ibrahim Natalwala, Nasim Tahir, Robert D Bains","doi":"10.1177/15385744231198944","DOIUrl":"10.1177/15385744231198944","url":null,"abstract":"<p><p>An otherwise healthy 9-month-old infant was treated for a true aneurysm of the proximal brachial artery. The swelling was first noted at seven months of age. An ultrasound scan showed a 2 cm × 2 cm aneurysm of the left brachial artery at the level of the mid-upper arm. Whole-body magnetic resonance angiography (MRA) confirmed this was a true aneurysm of the brachial artery; there was good distal runoff and no other aneurysms elsewhere. Vasculitis screen was negative. Surgical excision of the aneurysm and reconstruction of the brachial artery was performed with a reversed cephalic vein graft. The patient made an uneventful recovery and was discharged home. We present an overview of the workup report and emphasise that a multi-disciplinary team approach is imperative for assessing and managing this rare condition.</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":"10112977","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 : 2024-01-01Epub Date: 2023-07-09DOI: 10.1177/15385744231188803
Gerald A Cheadle, Amit J Dwivedi, Erik J Wayne, William G Cheadle, Abindra Sigdel
Objectives: Endovascular aortic repair may be complicated by type 2 endoleaks. Intervention is generally recommended when the native sac continues to grow more than 5 mm. Transcaval coil embolization (TCE) of the native aneurysm sac is an emerging technique for repair of type 2 endoleaks. The objective of this study is to report an institutional review of our experience with this technique.
Methods: 11 patients underwent TCE during the study period. Data were gathered on demographics, size increase of native aneurysm sac, operative details, and outcomes. Technical success was defined as resolution of the endoleak during completion sac angiogram at end of the procedure. Clinical success was defined as no growth in the aneurysm sac at interval follow-up.
Results: Coils were the embolant of choice in all cases. Technical success was achieved in all cases except 1 resulting in a 91% technical success rate. Median follow-up was 25 months (range, 3-33). Of the ten patients that had technically successful embolization, 8 patients had repeat computed tomography (CT) scans which showed no further expansion of the native sac resulting in a 80% clinical success rate. No complications were noted immediately post-op or at interval follow-up.
Conclusions: This institutional retrospective review demonstrates that TCE is an effective and safe option for type 2 endoleaks after endovascular aortic repair (EVAR) in selected patients with favorable anatomy. Longer term follow-up, more patients, and comparison studies are needed to further define durability and efficacy.
{"title":"Transcaval Coil Embolization of Type 2 Endoleak After Endovascular Aortic Repair: An Institutional Review.","authors":"Gerald A Cheadle, Amit J Dwivedi, Erik J Wayne, William G Cheadle, Abindra Sigdel","doi":"10.1177/15385744231188803","DOIUrl":"10.1177/15385744231188803","url":null,"abstract":"<p><strong>Objectives: </strong>Endovascular aortic repair may be complicated by type 2 endoleaks. Intervention is generally recommended when the native sac continues to grow more than 5 mm. Transcaval coil embolization (TCE) of the native aneurysm sac is an emerging technique for repair of type 2 endoleaks. The objective of this study is to report an institutional review of our experience with this technique.</p><p><strong>Methods: </strong>11 patients underwent TCE during the study period. Data were gathered on demographics, size increase of native aneurysm sac, operative details, and outcomes. Technical success was defined as resolution of the endoleak during completion sac angiogram at end of the procedure. Clinical success was defined as no growth in the aneurysm sac at interval follow-up.</p><p><strong>Results: </strong>Coils were the embolant of choice in all cases. Technical success was achieved in all cases except 1 resulting in a 91% technical success rate. Median follow-up was 25 months (range, 3-33). Of the ten patients that had technically successful embolization, 8 patients had repeat computed tomography (CT) scans which showed no further expansion of the native sac resulting in a 80% clinical success rate. No complications were noted immediately post-op or at interval follow-up.</p><p><strong>Conclusions: </strong>This institutional retrospective review demonstrates that TCE is an effective and safe option for type 2 endoleaks after endovascular aortic repair (EVAR) in selected patients with favorable anatomy. Longer term follow-up, more patients, and comparison studies are needed to further define durability and efficacy.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9765049","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 : 2024-01-01Epub Date: 2023-07-15DOI: 10.1177/15385744231189771
Amin A Mirzaie, Walker R Ueland, Katherine A Lambert, Amanda M Delgado, Jordan W Rosen, Carlos A Valdes, Salvatore T Scali, Thomas S Huber, Gilbert R Upchurch, Samir K Shah
Objective: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is an important data source for observational studies. While there are guides to ensure appropriate study reporting, there has been no evaluation of NSQIP studies in vascular surgery. We sought to evaluate the adherence of vascular-surgery related NSQIP studies to best reporting practices.
Methods: In January 2022, we queried PubMed for all vascular surgery NSQIP studies. We used the REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) statement and the JAMA Surgery (JAMA-Surgery) checklist to assess reporting methodology. We also extracted the Journal Impact Factor (IF) of each article.
Results: One hundred and fifty-nine studies published between 2002 and 2022 were identified and analyzed. The median score on the RECORD statement was 6 out of 8. The most commonly missed RECORD statement items were describing any validation of codes and providing data cleaning information. The median score on the JAMA-Surgery checklist was 2 out of 7. The most commonly missed JAMA-Surgery checklist items were identifying competing risks, using flow charts to help visualize study populations, having a solid research question and hypothesis, identifying confounders, and discussing the implications of missing data. We found no difference in the reporting methodology of studies published in high vs low IF journals.
Conclusion: Vascular surgery studies using NSQIP data demonstrate poor adherence to research reporting standards. Critical areas for improvement include identifying competing risks, including a solid research question and hypothesis, and describing any validation of codes. Journals should consider requiring authors use reporting guides to ensure their articles have stringent reporting methodology.
{"title":"Appraising the Quality of Reporting of Vascular Surgery Studies That Use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database.","authors":"Amin A Mirzaie, Walker R Ueland, Katherine A Lambert, Amanda M Delgado, Jordan W Rosen, Carlos A Valdes, Salvatore T Scali, Thomas S Huber, Gilbert R Upchurch, Samir K Shah","doi":"10.1177/15385744231189771","DOIUrl":"10.1177/15385744231189771","url":null,"abstract":"<p><strong>Objective: </strong>The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is an important data source for observational studies. While there are guides to ensure appropriate study reporting, there has been no evaluation of NSQIP studies in vascular surgery. We sought to evaluate the adherence of vascular-surgery related NSQIP studies to best reporting practices.</p><p><strong>Methods: </strong>In January 2022, we queried PubMed for all vascular surgery NSQIP studies. We used the REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) statement and the JAMA Surgery (JAMA-Surgery) checklist to assess reporting methodology. We also extracted the Journal Impact Factor (IF) of each article.</p><p><strong>Results: </strong>One hundred and fifty-nine studies published between 2002 and 2022 were identified and analyzed. The median score on the RECORD statement was 6 out of 8. The most commonly missed RECORD statement items were describing any validation of codes and providing data cleaning information. The median score on the JAMA-Surgery checklist was 2 out of 7. The most commonly missed JAMA-Surgery checklist items were identifying competing risks, using flow charts to help visualize study populations, having a solid research question and hypothesis, identifying confounders, and discussing the implications of missing data. We found no difference in the reporting methodology of studies published in high vs low IF journals.</p><p><strong>Conclusion: </strong>Vascular surgery studies using NSQIP data demonstrate poor adherence to research reporting standards. Critical areas for improvement include identifying competing risks, including a solid research question and hypothesis, and describing any validation of codes. Journals should consider requiring authors use reporting guides to ensure their articles have stringent reporting methodology.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155008","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 : 2024-01-01Epub Date: 2023-07-05DOI: 10.1177/15385744231188801
Jay M Bakas, Adriaan Moelker, Wendy S J Malskat, Marie Josee E Van Rijn
Venous stenting could alleviate exercise intolerance associated with chronic inferior vena cava (IVC) obstruction. We describe a 36-year-old male patient with an unknown IVC-obstruction. The obstruction was discovered after a bi-iliac deep vein thrombosis (DVT). The thrombus was resolved using thrombolysis. In the chronic phase, the patient developed exercise intolerance without any leg-specific symptoms or signs. Venous stenting was performed to open the IVC-obstruction, 1 year after the acute DVT. His physical condition improved, but cardiac magnetic resonance imaging at rest did not reveal hemodynamical changes after stenting. The Short Form Health Survey (SF-36) physical and mental component summaries were increased from 40.3 to 46.1 and 42.2 to 53.7, respectively. In patients with iliocaval obstruction, improved venous flow without changes in resting hemodynamics can enhance exercise intolerance and quality of life, even in the absence of leg symptoms. Diagnostic tools performed only at rest may miss abnormalities.
{"title":"Exercise Intolerance That Resolved After venous Stenting of the Inferior Vena Cava.","authors":"Jay M Bakas, Adriaan Moelker, Wendy S J Malskat, Marie Josee E Van Rijn","doi":"10.1177/15385744231188801","DOIUrl":"10.1177/15385744231188801","url":null,"abstract":"<p><p>Venous stenting could alleviate exercise intolerance associated with chronic inferior vena cava (IVC) obstruction. We describe a 36-year-old male patient with an unknown IVC-obstruction. The obstruction was discovered after a bi-iliac deep vein thrombosis (DVT). The thrombus was resolved using thrombolysis. In the chronic phase, the patient developed exercise intolerance without any leg-specific symptoms or signs. Venous stenting was performed to open the IVC-obstruction, 1 year after the acute DVT. His physical condition improved, but cardiac magnetic resonance imaging at rest did not reveal hemodynamical changes after stenting. The Short Form Health Survey (SF-36) physical and mental component summaries were increased from 40.3 to 46.1 and 42.2 to 53.7, respectively. In patients with iliocaval obstruction, improved venous flow without changes in resting hemodynamics can enhance exercise intolerance and quality of life, even in the absence of leg symptoms. Diagnostic tools performed only at rest may miss abnormalities.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9751339","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 : 2024-01-01Epub Date: 2023-07-09DOI: 10.1177/15385744231189361
Adam Tam, Ahmed Abdel-Rahim, Francis Dix, Jamie Barwell, Devender Mittapalli
Objectives: Colonic ischaemia is a rare but devastating complication of open aortic aneurysm repair and is associated with high morbidity and a mortality of up to 50%. The aim of this study was to determine the safety and effectiveness of using indocyanin green florescence (ICG) to interrogate colonic perfusion intra-operatively.
Design: Prospective observational study.
Methods: All elective open abdominal aneurysm repairs over a 6 month period underwent colonic perfusion interrogation with ICG according to a pre-defined protocol. Patient demographics and imaging findings were recorded prior to surgery. ICG was given just prior to laparotomy closure. Time to florescence was measured from the start of IV administration to surgeon defined maximal florescence of the sigmoid colon.
Results: Ten patients fulfilled the inclusion criteria. All patients were male with an average age of 69.7 years. Inferior mesenteric artery reimplantation was performed in 5 patients. Median colonic fluorescence time was 58 s. No complications related to ICG were identified. A single patient had clinical concern of colonic ischaemia and delayed perfusion (>3 min) on ICG; colorectal opinion advised not for immediate resection. At relook laparotomy, ischaemic colon at the area of demarcation was noted and a Hartmann's procedure was performed. No other patients had delayed perfusion and no further episodes of colonic ischaemia were noted. IMA reimplantation did not show statistical difference in colonic ICG time (P = .81, 95% CI -1.98 to 2.45). There was no statistical difference between operating times between the cohort and all repairs performed 6 months before the data collection (P = .59, 95% CI -.73 to 1.24).
Conclusion: In this pilot study ICG appears to be a safe and useful adjunct in objective assessment of colonic perfusion during open AAA repair. Further research is required to fully determine its role in this cohort of patients.
目的:结肠缺血是开放式主动脉瘤修复术中一种罕见但具有破坏性的并发症,其发病率和死亡率高达50%。本研究的目的是确定术中使用吲哚花青素绿色荧光(ICG)检测结肠灌注的安全性和有效性。设计:前瞻性观察研究。方法:所有6个月以上的开放性腹动脉瘤患者均按照预先设定的方案进行ICG结肠灌注问诊。术前记录患者人口统计学和影像学结果。ICG是在开腹前进行的。从静脉给药开始到外科医生定义的乙状结肠最大开花时间进行测量。结果:10例患者符合纳入标准。所有患者均为男性,平均年龄69.7岁。5例患者行肠系膜下动脉再植术。中位结肠荧光时间为58 s。未发现与ICG相关的并发症。1例患者在ICG上表现为结肠缺血和灌注延迟(bbb30 min);结直肠意见建议不立即切除。在剖腹检查时,注意到分界线区域的结肠缺血,并进行了哈特曼手术。没有其他患者出现灌注延迟,也没有进一步的结肠缺血发作。IMA重植在结肠ICG时间上无统计学差异(P = 0.81, 95% CI -1.98 ~ 2.45)。在数据收集前6个月进行的所有修复中,队列间的手术时间无统计学差异(P = 0.59, 95% CI -)。73比1.24)。结论:在这项初步研究中,ICG似乎是一种安全有效的辅助手段,可以客观评估开放式AAA修复期间的结肠灌注。需要进一步的研究来充分确定其在这组患者中的作用。
{"title":"Indocyanin Green Fluorescence Evaluation of Colonic Perfusion During Elective Open Abdominal Aortic Aneurysm Repair.","authors":"Adam Tam, Ahmed Abdel-Rahim, Francis Dix, Jamie Barwell, Devender Mittapalli","doi":"10.1177/15385744231189361","DOIUrl":"10.1177/15385744231189361","url":null,"abstract":"<p><strong>Objectives: </strong>Colonic ischaemia is a rare but devastating complication of open aortic aneurysm repair and is associated with high morbidity and a mortality of up to 50%. The aim of this study was to determine the safety and effectiveness of using indocyanin green florescence (ICG) to interrogate colonic perfusion intra-operatively.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Methods: </strong>All elective open abdominal aneurysm repairs over a 6 month period underwent colonic perfusion interrogation with ICG according to a pre-defined protocol. Patient demographics and imaging findings were recorded prior to surgery. ICG was given just prior to laparotomy closure. Time to florescence was measured from the start of IV administration to surgeon defined maximal florescence of the sigmoid colon.</p><p><strong>Results: </strong>Ten patients fulfilled the inclusion criteria. All patients were male with an average age of 69.7 years. Inferior mesenteric artery reimplantation was performed in 5 patients. Median colonic fluorescence time was 58 s. No complications related to ICG were identified. A single patient had clinical concern of colonic ischaemia and delayed perfusion (>3 min) on ICG; colorectal opinion advised not for immediate resection. At relook laparotomy, ischaemic colon at the area of demarcation was noted and a Hartmann's procedure was performed. No other patients had delayed perfusion and no further episodes of colonic ischaemia were noted. IMA reimplantation did not show statistical difference in colonic ICG time (<i>P</i> = .81, 95% CI -1.98 to 2.45). There was no statistical difference between operating times between the cohort and all repairs performed 6 months before the data collection (<i>P</i> = .59, 95% CI -.73 to 1.24).</p><p><strong>Conclusion: </strong>In this pilot study ICG appears to be a safe and useful adjunct in objective assessment of colonic perfusion during open AAA repair. Further research is required to fully determine its role in this cohort of patients.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764561","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 : 2024-01-01Epub Date: 2023-06-15DOI: 10.1177/15385744231184509
Julian M Corso-Ramirez, Mariana Molina López, Paula Camila Flórez, Juan Guillermo Barrera-Carvajal, Jaime Camacho Mackenzie
Tuberous sclerosis complex is a neurocutaneous syndrome caused by an autosomal dominant genetic disorder. This condition can lead to the expression of many vascular anomalies especially, in the pediatric population. Likewise, it has been linked with aortic aneurysm development. We report a case of a 12-year-old boy who presented a 97 × 70 mm Crawford type IV thoracoabdominal aortic aneurysm. Satisfactory open surgical repair was performed with an 18-mm multibranched dacron tube graft. Clinical and imaging findings revealed a de novo tuberous sclerosis diagnosis. The patient was discharged uneventfully during a 1-month follow-up.
{"title":"Open Emergency Repair of a Thoracoabdominal Aortic Aneurysm on a 12-Year-Old Boy With Tuberous Sclerosis.","authors":"Julian M Corso-Ramirez, Mariana Molina López, Paula Camila Flórez, Juan Guillermo Barrera-Carvajal, Jaime Camacho Mackenzie","doi":"10.1177/15385744231184509","DOIUrl":"10.1177/15385744231184509","url":null,"abstract":"<p><p>Tuberous sclerosis complex is a neurocutaneous syndrome caused by an autosomal dominant genetic disorder. This condition can lead to the expression of many vascular anomalies especially, in the pediatric population. Likewise, it has been linked with aortic aneurysm development. We report a case of a 12-year-old boy who presented a 97 × 70 mm Crawford type IV thoracoabdominal aortic aneurysm. Satisfactory open surgical repair was performed with an 18-mm multibranched dacron tube graft. Clinical and imaging findings revealed a de novo tuberous sclerosis diagnosis. The patient was discharged uneventfully during a 1-month follow-up.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9989241","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 : 2024-01-01Epub Date: 2023-06-27DOI: 10.1177/15385744231186272
Martin Wenkel, Nancy Halloum, Mohammad Bashar Izzat, Sadeq Ali-Hasan-Al-Saegh, Georg Daniel Duerr, Marc Kriege, Davor Stamenovic, Hendrik Treede, Hazem El Beyrouti
Objective: The presence of a significant left subclavian artery stenosis may occasionally lead to blood flow reversal through a LIMA-to-coronary artery bypass graft during left arm exertion; with "stealing" of myocardial blood supply. The aim of this study was to review our experience with carotid-subclavian bypass in patients with post-CABG coronary-subclavian steal syndrome.
Methods: This is a retrospective review of all patients who underwent carotid-subclavian bypass grafting for post-CABG coronary-subclavian steal syndrome at Mainz University Hospital between 2006 and 2015. Cases were identified in our institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records.
Results: Nine patients (all males, mean age of 69.1 years) underwent surgical treatment for post-CABG coronary-subclavian steal syndrome. Medium interval between original CABG and carotid-subclavian bypass grafting was 86.1 months. There were no perioperative deaths, strokes or myocardial infarctions. At a mean follow-up period of 79.9 months, all patients remained asymptomatic and all carotid-subclavian bypass grafts remained patent. One patient required stenting of a common carotid artery stenosis proximal to the graft anastomosis site, and coronary artery stenting was required in four patients in regions other than those supplied by the patent LIMA graft.
Conclusion: Carotid-subclavian bypass surgery is a safe treatment option even in patients with multivessel disease and severe comorbidities and should be taken into consideration in patients who are deemed fit for surgery and those who would benefit from the excellent long-term patency rates.
{"title":"Long-Term Outcome of Carotid-Subclavian Bypass in the Management of Coronary-Subclavian Steal Syndrome.","authors":"Martin Wenkel, Nancy Halloum, Mohammad Bashar Izzat, Sadeq Ali-Hasan-Al-Saegh, Georg Daniel Duerr, Marc Kriege, Davor Stamenovic, Hendrik Treede, Hazem El Beyrouti","doi":"10.1177/15385744231186272","DOIUrl":"10.1177/15385744231186272","url":null,"abstract":"<p><strong>Objective: </strong>The presence of a significant left subclavian artery stenosis may occasionally lead to blood flow reversal through a LIMA-to-coronary artery bypass graft during left arm exertion; with \"stealing\" of myocardial blood supply. The aim of this study was to review our experience with carotid-subclavian bypass in patients with post-CABG coronary-subclavian steal syndrome.</p><p><strong>Methods: </strong>This is a retrospective review of all patients who underwent carotid-subclavian bypass grafting for post-CABG coronary-subclavian steal syndrome at Mainz University Hospital between 2006 and 2015. Cases were identified in our institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records.</p><p><strong>Results: </strong>Nine patients (all males, mean age of 69.1 years) underwent surgical treatment for post-CABG coronary-subclavian steal syndrome. Medium interval between original CABG and carotid-subclavian bypass grafting was 86.1 months. There were no perioperative deaths, strokes or myocardial infarctions. At a mean follow-up period of 79.9 months, all patients remained asymptomatic and all carotid-subclavian bypass grafts remained patent. One patient required stenting of a common carotid artery stenosis proximal to the graft anastomosis site, and coronary artery stenting was required in four patients in regions other than those supplied by the patent LIMA graft.</p><p><strong>Conclusion: </strong>Carotid-subclavian bypass surgery is a safe treatment option even in patients with multivessel disease and severe comorbidities and should be taken into consideration in patients who are deemed fit for surgery and those who would benefit from the excellent long-term patency rates.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743107","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 : 2024-01-01Epub Date: 2023-06-15DOI: 10.1177/15385744231184654
Ziya Yıldız, Mehmet A Kayğın, Taha Özkara, Hüsnü K Limandal, Mevriye S Diler, Hatice I Çüçen Dayı, Servet Ergün, Özgür Dağ
Objectives: The present study aimed to compare the effects of medical therapy (MT), systemic thrombolysis (ST), and pharmacomechanical thrombolysis (PMT) methods used in our clinic for the treatment of deep venous thrombosis (DVT) on symptom reduction, the incidence of post-thrombotic syndrome (PTS) development, and quality of life.
Methods: Data from160 patients diagnosed with acute DVT between January 2012 and May 2021 and treated and followed up in our clinic were retrospectively analyzed. The patients were divided into three groups according to treatment method. The patients who received MT treatment were defined as Group 1, anticoagulant treatment after ST as Group 2, and anticoagulant treatment after PMT as Group 3. The patients were called to the outpatient clinic, informed consent was obtained, EuroQol-5D-3 L (EQ-5D-3 L) scoring and Villalta scoring were performed, and anamnesis was taken.
Results: A total of 160 patients were included, with 71 (44.4%) patients in Group 1, 45 (28.1%) in Group 2, and 44 (27.5%) in Group 3. The mean age was 48.9 ± 14.9 years for Group 1, 42.2 ± 10.8 for Group 2, and 29.0 ± 7.2 for Group 3. When the time to return to normal life and the EQ-5D-3 L score index were compared, the differences between Groups 1 and 2 and between Groups 1 and 3 were statistically significant (P = .000 and P = .000, respectively). However, the differences between Groups 2 and 3 were statistically insignificant (P = .213 andp = .074, respectively). When Villalta scores and EQ Visual Analogue Scale (EQ-VAS) scores were compared between groups, the difference between all groups was statistically significant (P = .000).
Conclusions: The medical treatment alone was observed to be insufficient in terms of symptomatic improvement, development of PTS, quality of life, and long-term complications. When the ST and PMT groups were compared, it was determined that PMT treatment was more advantageous in terms of EQ-VAS score and PTS development, although there was no statistical difference regarding complications, such as return to normal life and long-term quality of life, the incidence of recurrent DVT development, and pulmonary thromboembolism incidence.
{"title":"Effects of Deep Venous Thrombosis Treatments on Early and Long-term Quality of Life: Medical Therapy vs. Systemic Thrombolysis vs. Pharmacomechanical Thrombolysis.","authors":"Ziya Yıldız, Mehmet A Kayğın, Taha Özkara, Hüsnü K Limandal, Mevriye S Diler, Hatice I Çüçen Dayı, Servet Ergün, Özgür Dağ","doi":"10.1177/15385744231184654","DOIUrl":"10.1177/15385744231184654","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aimed to compare the effects of medical therapy (MT), systemic thrombolysis (ST), and pharmacomechanical thrombolysis (PMT) methods used in our clinic for the treatment of deep venous thrombosis (DVT) on symptom reduction, the incidence of post-thrombotic syndrome (PTS) development, and quality of life.</p><p><strong>Methods: </strong>Data from160 patients diagnosed with acute DVT between January 2012 and May 2021 and treated and followed up in our clinic were retrospectively analyzed. The patients were divided into three groups according to treatment method. The patients who received MT treatment were defined as Group 1, anticoagulant treatment after ST as Group 2, and anticoagulant treatment after PMT as Group 3. The patients were called to the outpatient clinic, informed consent was obtained, EuroQol-5D-3 L (EQ-5D-3 L) scoring and Villalta scoring were performed, and anamnesis was taken.</p><p><strong>Results: </strong>A total of 160 patients were included, with 71 (44.4%) patients in Group 1, 45 (28.1%) in Group 2, and 44 (27.5%) in Group 3. The mean age was 48.9 ± 14.9 years for Group 1, 42.2 ± 10.8 for Group 2, and 29.0 ± 7.2 for Group 3. When the time to return to normal life and the EQ-5D-3 L score index were compared, the differences between Groups 1 and 2 and between Groups 1 and 3 were statistically significant (<i>P</i> = .000 and <i>P</i> = .000, respectively). However, the differences between Groups 2 and 3 were statistically insignificant (<i>P</i> = .213 and<i>p</i> = .074, respectively). When Villalta scores and EQ Visual Analogue Scale (EQ-VAS) scores were compared between groups, the difference between all groups was statistically significant (<i>P</i> = .000).</p><p><strong>Conclusions: </strong>The medical treatment alone was observed to be insufficient in terms of symptomatic improvement, development of PTS, quality of life, and long-term complications. When the ST and PMT groups were compared, it was determined that PMT treatment was more advantageous in terms of EQ-VAS score and PTS development, although there was no statistical difference regarding complications, such as return to normal life and long-term quality of life, the incidence of recurrent DVT development, and pulmonary thromboembolism incidence.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9637121","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 : 2024-01-01Epub Date: 2023-07-19DOI: 10.1177/15385744231191234
Andrea Xodo, Jacopo Taglialavoro, Sandro Lepidi, Fabio Pilon, Cristiano Calvagna, Filippo Griselli, Domenico Milite, Giovanni Badalamenti, Barbara Ruaro, Mario D'Oria
Purpose: To demonstrate the feasibility and outcomes of using the microvascular plug (MVP) for intentional occlusion of directional branches (DB) during complex endovascular aortic procedures.
Case report: Two patients were treated with the off-the-shelf four-branched Zenith t-Branch thoracoabdominal stent-graft (Cook Medical, Bloomington, Ind). In both cases, the renal arteries (on one side in patient #1 and on both sides in patient #2, respectively) were occluded at time of index intervention. Preoperative planning included the intentional occlusion of each DB with one 7Q-MVP. Technical success was achieved in all cases and maintained at mid-term follow-up (12 months and 36 months, respectively).
Conclusions: Use of the MVP appears to be feasible and effective for intentional occlusion of DB during complex endovascular aortic repair. This novel and simple technique may present some unique technical advantages, allowing precise placement of the device while avoiding extension using a bridging stent and DB cannulation with larger sheaths.
{"title":"Novel Technique for Intentional Occlusion of Directional Branches During Complex Endovascular Aortic Repair Using Microvascular Plugs.","authors":"Andrea Xodo, Jacopo Taglialavoro, Sandro Lepidi, Fabio Pilon, Cristiano Calvagna, Filippo Griselli, Domenico Milite, Giovanni Badalamenti, Barbara Ruaro, Mario D'Oria","doi":"10.1177/15385744231191234","DOIUrl":"10.1177/15385744231191234","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate the feasibility and outcomes of using the microvascular plug (MVP) for intentional occlusion of directional branches (DB) during complex endovascular aortic procedures.</p><p><strong>Case report: </strong>Two patients were treated with the off-the-shelf four-branched Zenith t-Branch thoracoabdominal stent-graft (Cook Medical, Bloomington, Ind). In both cases, the renal arteries (on one side in patient #1 and on both sides in patient #2, respectively) were occluded at time of index intervention. Preoperative planning included the intentional occlusion of each DB with one 7Q-MVP. Technical success was achieved in all cases and maintained at mid-term follow-up (12 months and 36 months, respectively).</p><p><strong>Conclusions: </strong>Use of the MVP appears to be feasible and effective for intentional occlusion of DB during complex endovascular aortic repair. This novel and simple technique may present some unique technical advantages, allowing precise placement of the device while avoiding extension using a bridging stent and DB cannulation with larger sheaths.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829422","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 : 2024-01-01Epub Date: 2023-07-03DOI: 10.1177/15385744231186276
Anouk Van Gerwen, Sarah Gallala, Laura Kerselaers, Dimitri Aerden, Erik Debing
Introduction: Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.
Methods: All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO.
Results: A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (P .015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (P .021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64).
Conclusion: The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients.
{"title":"Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors.","authors":"Anouk Van Gerwen, Sarah Gallala, Laura Kerselaers, Dimitri Aerden, Erik Debing","doi":"10.1177/15385744231186276","DOIUrl":"10.1177/15385744231186276","url":null,"abstract":"<p><strong>Introduction: </strong>Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.</p><p><strong>Methods: </strong>All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO.</p><p><strong>Results: </strong>A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (<i>P</i> .015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (<i>P</i> .021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64).</p><p><strong>Conclusion: </strong>The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9746788","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}