Pub Date : 2023-10-01Epub Date: 2023-03-22DOI: 10.1177/15385744231165877
Julio Cesar Peclat de Oliveira, Rossano Kepler Alvim Fiorelli, Ana Paula Rolim Maia Peclat, Lucas Maia Peclat de Oliveira, Rafael Oliveira, Sergio Quilici Belczac, Renato Santos Almeida, Marcelo Bellini Dalio, Edwaldo Edner Joviliano, Bianca Gutfilen
Background: In-stent restenosis remains a common and important complication after endovascular treatment of superficial femoral artery peripheral artery disease. It occurs in 14 to 35% of cases in 1 year and there is still no efficient treatment for this condition. Paclitaxel-coated balloons have shown promising results.
Objective: Investigate the 3 year results of superficial femoral artery in-stent restenosis treated with paclitaxel-coated balloon angioplasty, using the Lutonix™ 035 device.
Methods: We conducted a retrospective observational study with patients with symptomatic (Rutherford 2 to 5) superficial femoral artery in-stent restenosis, that were treated with paclitaxel-coated balloon angioplasty using the Lutonix™ 035 device, in a single center from January 2016 to December 2020. Duplex scan was used to follow the patients. Primary patency was obtained through Kaplan-Meier analysis. Mortality, and amputation rates were also evaluated.
Results: 105 patients were included. Two patients had technical failure and required an additional stent, and were thus excluded. 103 patients were analyzed. Primary patency was 91.26, 80.47, and 67.71%, respectively, in the first, second, and third year after the procedure. There were no deaths 30 days after the procedure. There were no major amputations during the 3 year follow-up.
Conclusion: Paclitaxel-coated balloon angioplasty with the Lutonix™ 035 device was a safe and effective treatment to superficial femoral artery in-stent restenoses. The results were maintained along the 3 year follow-up.
{"title":"Superficial Femoral Artery in-Stent Restenosis Treated with Paclitaxel-Coated Balloon Angioplasty - Results of Three-Year Follow-Up.","authors":"Julio Cesar Peclat de Oliveira, Rossano Kepler Alvim Fiorelli, Ana Paula Rolim Maia Peclat, Lucas Maia Peclat de Oliveira, Rafael Oliveira, Sergio Quilici Belczac, Renato Santos Almeida, Marcelo Bellini Dalio, Edwaldo Edner Joviliano, Bianca Gutfilen","doi":"10.1177/15385744231165877","DOIUrl":"10.1177/15385744231165877","url":null,"abstract":"<p><strong>Background: </strong>In-stent restenosis remains a common and important complication after endovascular treatment of superficial femoral artery peripheral artery disease. It occurs in 14 to 35% of cases in 1 year and there is still no efficient treatment for this condition. Paclitaxel-coated balloons have shown promising results.</p><p><strong>Objective: </strong>Investigate the 3 year results of superficial femoral artery in-stent restenosis treated with paclitaxel-coated balloon angioplasty, using the Lutonix™ 035 device.</p><p><strong>Methods: </strong>We conducted a retrospective observational study with patients with symptomatic (Rutherford 2 to 5) superficial femoral artery in-stent restenosis, that were treated with paclitaxel-coated balloon angioplasty using the Lutonix™ 035 device, in a single center from January 2016 to December 2020. Duplex scan was used to follow the patients. Primary patency was obtained through Kaplan-Meier analysis. Mortality, and amputation rates were also evaluated.</p><p><strong>Results: </strong>105 patients were included. Two patients had technical failure and required an additional stent, and were thus excluded. 103 patients were analyzed. Primary patency was 91.26, 80.47, and 67.71%, respectively, in the first, second, and third year after the procedure. There were no deaths 30 days after the procedure. There were no major amputations during the 3 year follow-up.</p><p><strong>Conclusion: </strong>Paclitaxel-coated balloon angioplasty with the Lutonix™ 035 device was a safe and effective treatment to superficial femoral artery in-stent restenoses. The results were maintained along the 3 year follow-up.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9509349","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 : 2023-10-01Epub Date: 2023-03-24DOI: 10.1177/15385744231166797
Konstantinos G Moulakakis, Andreas Tsimpoukis, Konstantinos Katsanos, Eleni Sintou, Spyros Papadoulas
Re-rupture 2 years after endovascular aortic aneurysm repair (EVAR) rupture is an extremely rare event and limited data exist in the literature. We present an interesting case of a patient with an abdominal aortic rupture that had undergone 2 years before an endovascular repair for rupture after EVAR due to a type IA endoleak. The patient underwent a successful embolization of the type IA endoleak. Onyx was used to seal the gutter between the aortic wall and the endograft and the 1-month post-embolization CT showed complete sealing with no contrast in the sac. Two years after the rupture, he was presented again with clinical signs of hemodynamic shock and instability. An urgent CT Angiograph showed again rupture due to a type IA endoleak. The patient underwent an emergency open laparotomy. We analyze the re-rupture after EVAR while taking data from the literature into account.
{"title":"Re-Rupture 2 Years after Endovascular Aortic Aneurysm Repair Rupture.","authors":"Konstantinos G Moulakakis, Andreas Tsimpoukis, Konstantinos Katsanos, Eleni Sintou, Spyros Papadoulas","doi":"10.1177/15385744231166797","DOIUrl":"10.1177/15385744231166797","url":null,"abstract":"<p><p>Re-rupture 2 years after endovascular aortic aneurysm repair (EVAR) rupture is an extremely rare event and limited data exist in the literature. We present an interesting case of a patient with an abdominal aortic rupture that had undergone 2 years before an endovascular repair for rupture after EVAR due to a type IA endoleak. The patient underwent a successful embolization of the type IA endoleak. Onyx was used to seal the gutter between the aortic wall and the endograft and the 1-month post-embolization CT showed complete sealing with no contrast in the sac. Two years after the rupture, he was presented again with clinical signs of hemodynamic shock and instability. An urgent CT Angiograph showed again rupture due to a type IA endoleak. The patient underwent an emergency open laparotomy. We analyze the re-rupture after EVAR while taking data from the literature into account.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9161348","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 : 2023-10-01Epub Date: 2023-04-14DOI: 10.1177/15385744231170919
Nicole Kus, Justin A Robinson, Michael R Hall, Mehrdad Ghoreishi, Bradley Taylor, Shahab Toursavadkohi
To date, emergent total endovascular aortic arch repair has not been described in the literature. We present a 67-year-old female with a poorly differentiated posterior mediastinal sarcoma. Imaging obtained was concerning for intravascular extension of the tumor into the thoracic aorta. While awaiting radiation therapy, the patient complained of worsening chest and arm pain, vital signs demonstrating tachypnea and hypoxia. Subsequent imaging revealed an increase in vascular erosion, concerning for a contained rupture, with complete obliteration of the left mainstem bronchus. The patient was emergently taken for percutaneous endovascular repair of her aortic arch. A three-vessel physician modified fenestrated graft was created and deployed with concurrent stenting of the innominate, left carotid, and left subclavian arteries. Interval computed tomography angiography revealed patency in all stented vessels, with no endoleak and no evidence of pseudoaneurysm. The patient was able to undergo chemotherapy with favorable decrease in tumor burden. Total endovascular aortic arch repair, when planned carefully, is an attractive option in high-risk patients who are otherwise not ideally suited for open total arch replacement.
{"title":"Emergent Total Endovascular Arch Repair for Contained Aortic Arch Rupture: Another Tool in the Box.","authors":"Nicole Kus, Justin A Robinson, Michael R Hall, Mehrdad Ghoreishi, Bradley Taylor, Shahab Toursavadkohi","doi":"10.1177/15385744231170919","DOIUrl":"10.1177/15385744231170919","url":null,"abstract":"<p><p>To date, emergent total endovascular aortic arch repair has not been described in the literature. We present a 67-year-old female with a poorly differentiated posterior mediastinal sarcoma. Imaging obtained was concerning for intravascular extension of the tumor into the thoracic aorta. While awaiting radiation therapy, the patient complained of worsening chest and arm pain, vital signs demonstrating tachypnea and hypoxia. Subsequent imaging revealed an increase in vascular erosion, concerning for a contained rupture, with complete obliteration of the left mainstem bronchus. The patient was emergently taken for percutaneous endovascular repair of her aortic arch. A three-vessel physician modified fenestrated graft was created and deployed with concurrent stenting of the innominate, left carotid, and left subclavian arteries. Interval computed tomography angiography revealed patency in all stented vessels, with no endoleak and no evidence of pseudoaneurysm. The patient was able to undergo chemotherapy with favorable decrease in tumor burden. Total endovascular aortic arch repair, when planned carefully, is an attractive option in high-risk patients who are otherwise not ideally suited for open total arch replacement.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287468","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 : 2023-10-01Epub Date: 2023-04-21DOI: 10.1177/15385744231171746
Torbjörn Fransson, Anders Gottsäter, Mohammad Abdulrasak, Martin Malina, Timothy Resch
Objective: Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery.
Methods: Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years.
Results: A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes.
Conclusions: This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.
{"title":"Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia.","authors":"Torbjörn Fransson, Anders Gottsäter, Mohammad Abdulrasak, Martin Malina, Timothy Resch","doi":"10.1177/15385744231171746","DOIUrl":"10.1177/15385744231171746","url":null,"abstract":"<p><strong>Objective: </strong>Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery.</p><p><strong>Methods: </strong>Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years.</p><p><strong>Results: </strong>A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes.</p><p><strong>Conclusions: </strong>This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9415587","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 : 2023-10-01Epub Date: 2023-04-18DOI: 10.1177/15385744231171754
Levi Godard, Linda Lee, Brandon McGuinness, Hemlata Shirsat, Nathan Hoag
Bacillus Calmette-Guerin (BCG) therapy for treatment of bladder cancer is a rare cause of Mycobacterium bovis infected aortic aneurysm. Typical presentations have included general malaise, fever, and lower back pain. We present a case with lower back pain and constipation as presenting symptoms, leading to diagnosis of mycotic aneurysm presumed secondary to intravesical BCG therapy. Treatment included open surgical repair with femoral vein grafting and anti-tubercular therapy. This case highlights the importance of a high index of suspicion for less common infectious complications of BCG therapy.
{"title":"Mycotic Abdominal Aortic Aneurysm Secondary to BCG Therapy for Non-muscle Invasive Urothelial Carcinoma of the Bladder.","authors":"Levi Godard, Linda Lee, Brandon McGuinness, Hemlata Shirsat, Nathan Hoag","doi":"10.1177/15385744231171754","DOIUrl":"10.1177/15385744231171754","url":null,"abstract":"Bacillus Calmette-Guerin (BCG) therapy for treatment of bladder cancer is a rare cause of Mycobacterium bovis infected aortic aneurysm. Typical presentations have included general malaise, fever, and lower back pain. We present a case with lower back pain and constipation as presenting symptoms, leading to diagnosis of mycotic aneurysm presumed secondary to intravesical BCG therapy. Treatment included open surgical repair with femoral vein grafting and anti-tubercular therapy. This case highlights the importance of a high index of suspicion for less common infectious complications of BCG therapy.","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/04/10.1177_15385744231171754.PMC10517576.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9323236","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 : 2023-10-01Epub Date: 2023-03-23DOI: 10.1177/15385744221144503
Roi Abramov, Liel Rufizen, Hayim Gilshtein
Background: Lymphangiomyomatosis is a rare disease involving the lymph vessels, causing obstruction and cystic formation with an incidence of 3-8 per million women. The disease might be sporadic or inherited. Lymphangiomyomatosis mostly affects the pulmonary system, whereas extrapulmonary Lymphangiomyomatosis may present in various site, occasionally as a localized abdominal mass. The diagnostic process might entail surgical resection to obtain a specimen for pathology that may also help to achieve a long-term control of the disease. Methods: Herein, we present a case of a 45 years old female, who suffered from pulmonary symptoms, and during her workup an abdominal mass was found. The patient underwent exploratory laparotomy with resection of a left retroperitoneal bilobar mass. Results: Histopathological report revealed Lymphangiomyoma. She had a complication of a lymphatic leakage that required a second laparotomy with satisfactory clinical outcome. Conclusions: Surgeons should be aware of the pathological lymphatics and manage post-operative complications by a trial of conservative.
{"title":"Resection of Extrapulmonary Lymphangiomyoma and Post-Operative Management Considerations.","authors":"Roi Abramov, Liel Rufizen, Hayim Gilshtein","doi":"10.1177/15385744221144503","DOIUrl":"10.1177/15385744221144503","url":null,"abstract":"<p><p><b>Background:</b> Lymphangiomyomatosis is a rare disease involving the lymph vessels, causing obstruction and cystic formation with an incidence of 3-8 per million women. The disease might be sporadic or inherited. Lymphangiomyomatosis mostly affects the pulmonary system, whereas extrapulmonary Lymphangiomyomatosis may present in various site, occasionally as a localized abdominal mass. The diagnostic process might entail surgical resection to obtain a specimen for pathology that may also help to achieve a long-term control of the disease. <b>Methods:</b> Herein, we present a case of a 45 years old female, who suffered from pulmonary symptoms, and during her workup an abdominal mass was found. The patient underwent exploratory laparotomy with resection of a left retroperitoneal bilobar mass. <b>Results:</b> Histopathological report revealed Lymphangiomyoma. She had a complication of a lymphatic leakage that required a second laparotomy with satisfactory clinical outcome. <b>Conclusions:</b> Surgeons should be aware of the pathological lymphatics and manage post-operative complications by a trial of conservative.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9535146","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 : 2023-10-01Epub Date: 2023-03-20DOI: 10.1177/15385744231165155
Soroosh Noorbakhsh, Lissette Gomez, Yoo Joung, Courtney Meyer, Dustin S Hanos, Mari Freedberg, Nathan Klingensmith, April A Grant, Deepika Koganti, Jonathan Nguyen, Randi N Smith, Jason D Sciarretta
Purpose: Hepatic arterioportal fistula (HAPF) is an uncommon complication of hepatic trauma, which can manifest with abdominal pain and the sequelae of portal hypertension months to years after injury. The purpose of this study is to present cases of HAPF from our busy urban trauma center and make recommendations for management.
Methods: One hundred and twenty-seven patients with high-grade penetrating liver injuries (American Association for the Surgery of Trauma [AAST] - Grades IV-V) between January 2019 and October 2022 were retrospectively reviewed. Five patients were identified with an acute hepatic arterioportal fistula following abdominal trauma from our ACS-verified adult Level 1 trauma center. Institutional experience with overall surgical management is described and reviewed with the current literature.
Results: Four of our patients presented in hemorrhagic shock requiring emergent operative intervention. The first patient had postoperative angiography and coil embolization of the HAPF. Patients 2 through 4 underwent damage control laparotomy with temporary abdominal closure followed by postoperative transarterial embolization with gelatin sponge particles (Gelfoam) or combined Gelfoam/n-butyl cyanoacrylate. The final patient went directly for angiography and Gelfoam embolization after identification of the HAPF. All 5 patients had resolution of HAPF on follow-up imaging with continued post management for traumatic injuries.
Conclusion: Hepatic arterioportal fistula can present as a complication of hepatic injury and manifest with significant hemodynamic aberrations. Although surgical intervention was required to achieve hemorrhage control in almost all cases, management of HAPF in the setting of high-grade liver injuries was achieved successfully with modern endovascular techniques. A multidisciplinary approach to such injuries is necessary to optimize care in the acute setting following traumatic injury.
{"title":"Hepatic Arterioportal Fistula Following Liver Trauma: Case Series and Review of the Literature.","authors":"Soroosh Noorbakhsh, Lissette Gomez, Yoo Joung, Courtney Meyer, Dustin S Hanos, Mari Freedberg, Nathan Klingensmith, April A Grant, Deepika Koganti, Jonathan Nguyen, Randi N Smith, Jason D Sciarretta","doi":"10.1177/15385744231165155","DOIUrl":"10.1177/15385744231165155","url":null,"abstract":"<p><strong>Purpose: </strong>Hepatic arterioportal fistula (HAPF) is an uncommon complication of hepatic trauma, which can manifest with abdominal pain and the sequelae of portal hypertension months to years after injury. The purpose of this study is to present cases of HAPF from our busy urban trauma center and make recommendations for management.</p><p><strong>Methods: </strong>One hundred and twenty-seven patients with high-grade penetrating liver injuries (American Association for the Surgery of Trauma [AAST] - Grades IV-V) between January 2019 and October 2022 were retrospectively reviewed. Five patients were identified with an acute hepatic arterioportal fistula following abdominal trauma from our ACS-verified adult Level 1 trauma center. Institutional experience with overall surgical management is described and reviewed with the current literature.</p><p><strong>Results: </strong>Four of our patients presented in hemorrhagic shock requiring emergent operative intervention. The first patient had postoperative angiography and coil embolization of the HAPF. Patients 2 through 4 underwent damage control laparotomy with temporary abdominal closure followed by postoperative transarterial embolization with gelatin sponge particles (Gelfoam) or combined Gelfoam/n-butyl cyanoacrylate. The final patient went directly for angiography and Gelfoam embolization after identification of the HAPF. All 5 patients had resolution of HAPF on follow-up imaging with continued post management for traumatic injuries.</p><p><strong>Conclusion: </strong>Hepatic arterioportal fistula can present as a complication of hepatic injury and manifest with significant hemodynamic aberrations. Although surgical intervention was required to achieve hemorrhage control in almost all cases, management of HAPF in the setting of high-grade liver injuries was achieved successfully with modern endovascular techniques. A multidisciplinary approach to such injuries is necessary to optimize care in the acute setting following traumatic injury.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9141116","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 : 2023-10-01Epub Date: 2023-04-25DOI: 10.1177/15385744231173198
Ashley Penton, Matthew DeJong, Tara Zielke, Janice Nam, Matthew Blecha
Objective: Adverse perioperative events and discharge medications both have the potential to impact survival following endovascular abdominal aortic aneurysm repair (EVAR). We hypothesize that variables such as blood loss, reoperation in the same hospital admission, and lack of discharge statin/aspirin have significant effect on long term survival following EVAR. Similarly, other perioperative morbidities, are hypothesized to affect long term mortality. Quantifying the mortality effect of perioperative events and treatment emphasizes to physicians the critical nature of preoperative optimization, case planning, operative execution and postoperative patient management.
Methods: All EVAR in the Vascular Quality Initiative between 2003 and 2021 were queried. Exclusions were: ruptured/symptomatic aneurysm; concomitant renal artery or supra-renal intervention at the time of EVAR; conversion to open aneurysm repair at the time of initial operation; and undocumented mortality status at the 5 year mark postoperatively. 18,710 patients met inclusion criteria. Multivariable Cox regression time dependent analysis was performed to investigate the strength of mortality association of the exposure variables. Standard demographic variables and pre-existing major co-morbidities were included in the regression analysis to account for disproportionate, deleterious co-variables amongst those experiencing the various morbidities. Kaplan-Meier survival analysis was performed to provide survival curves for the key variables.
Results: Mean follow up was 5.99 years and 5-year survival for included patients was 69.2%. Cox regression revealed increased long term mortality to be associated with the following perioperative events: reoperation during the index hospital admission (HR 1.21, P = .034), perioperative leg ischemia (HR 1.34, P = .014), perioperative acute renal insufficiency (HR 1.24, P = .013), perioperative myocardial infarction (HR 1.87, P < .001), perioperative intestinal ischemia (HR 2.13, P < .001), perioperative respiratory failure (HR 2.15, P < .001), lack of discharge aspirin (HR 1.26, P < .001), and lack of discharge statin (HR 1.26, P < .001). The following pre-existing co-morbidities correlated with increased long term mortality (P < .001 for all) : body mass index under 20 kg/m2, hypertension, diabetes, coronary artery disease, reported history congestive heart failure, chronic obstructive pulmonary disease, peripheral artery disease, advancing age, baseline renal insufficiency and left ventricular ejection fraction less than 50%. Females were more likely to have EBL >300 mL, reoperation, perioperative MI, limb ischemia and acute renal insufficiency than males (P < .01 for all). Female sex trended but was not associated with increased long term mortality risk (HR 1.06, 95% CI .995-1.14, P = .072).
{"title":"The Impact of Perioperative Morbidities, Lack of Discharge Aspirin, and Lack of Discharge Statin on Long Term Survival Following EVAR.","authors":"Ashley Penton, Matthew DeJong, Tara Zielke, Janice Nam, Matthew Blecha","doi":"10.1177/15385744231173198","DOIUrl":"10.1177/15385744231173198","url":null,"abstract":"<p><strong>Objective: </strong>Adverse perioperative events and discharge medications both have the potential to impact survival following endovascular abdominal aortic aneurysm repair (EVAR). We hypothesize that variables such as blood loss, reoperation in the same hospital admission, and lack of discharge statin/aspirin have significant effect on long term survival following EVAR. Similarly, other perioperative morbidities, are hypothesized to affect long term mortality. Quantifying the mortality effect of perioperative events and treatment emphasizes to physicians the critical nature of preoperative optimization, case planning, operative execution and postoperative patient management.</p><p><strong>Methods: </strong>All EVAR in the Vascular Quality Initiative between 2003 and 2021 were queried. Exclusions were: ruptured/symptomatic aneurysm; concomitant renal artery or supra-renal intervention at the time of EVAR; conversion to open aneurysm repair at the time of initial operation; and undocumented mortality status at the 5 year mark postoperatively. 18,710 patients met inclusion criteria. Multivariable Cox regression time dependent analysis was performed to investigate the strength of mortality association of the exposure variables. Standard demographic variables and pre-existing major co-morbidities were included in the regression analysis to account for disproportionate, deleterious co-variables amongst those experiencing the various morbidities. Kaplan-Meier survival analysis was performed to provide survival curves for the key variables.</p><p><strong>Results: </strong>Mean follow up was 5.99 years and 5-year survival for included patients was 69.2%. Cox regression revealed increased long term mortality to be associated with the following perioperative events: reoperation during the index hospital admission (HR 1.21, <i>P</i> = .034), perioperative leg ischemia (HR 1.34, <i>P</i> = .014), perioperative acute renal insufficiency (HR 1.24, <i>P</i> = .013), perioperative myocardial infarction (HR 1.87, <i>P</i> < .001), perioperative intestinal ischemia (HR 2.13, <i>P</i> < .001), perioperative respiratory failure (HR 2.15, <i>P</i> < .001), lack of discharge aspirin (HR 1.26, <i>P</i> < .001), and lack of discharge statin (HR 1.26, <i>P</i> < .001). The following pre-existing co-morbidities correlated with increased long term mortality (<i>P</i> < .001 for all) : body mass index under 20 kg/m<sup>2</sup>, hypertension, diabetes, coronary artery disease, reported history congestive heart failure, chronic obstructive pulmonary disease, peripheral artery disease, advancing age, baseline renal insufficiency and left ventricular ejection fraction less than 50%. Females were more likely to have EBL >300 mL, reoperation, perioperative MI, limb ischemia and acute renal insufficiency than males (<i>P</i> < .01 for all). Female sex trended but was not associated with increased long term mortality risk (HR 1.06, 95% CI .995-1.14, <i>P</i> = .072).</p","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9342063","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 : 2023-10-01Epub Date: 2023-04-18DOI: 10.1177/15385744231171752
Arsalan Wafi, Vijay Kolli, Bilal Azhar, Grace Poole, James Budge, Paul Moxey, Ian Loftus, Peter Holt
Objectives: The aim of this study was to compare outcomes of major lower limb amputation (MLA) in patients with and without cancer and with cancer patients receiving palliation over amputation for their unsalvageable limb.
Methods: Cancer patients who underwent a major amputation or palliation between 2013 and 2018 were included. Comparison groups were cancer-MLA (active/managed cancers), non-cancer MLA (historic cancer or no cancer history) and cancer-palliation at presentation with unsalvageable limbs. Prospectively collected data was retrospectively analysed for outcomes including survival, postoperative complications, length of stay, suitability for rehabilitation and discharge destination.
Results: 262 (cancer and non-cancer) patients underwent MLA and 18 patients with cancer received palliation. Of those amputated, 26 (9.9%) had active or managed cancer, of which 12 were diagnosed in the 6 months before MLA. Cancer-MLA patients presented with more acute ischaemia compared to non-cancer patients. Median survival was significantly different between the cancer-MLA (14.1 [9.5 - 29.5, 95% CI] months), non-cancer MLA (57.7 [45 - 73.6, 95% CI] months) and cancer-palliation (.6 [.4 - 2.3, 95% CI] months) groups, P < .001. A significantly higher proportion of cancer-MLA patients (10/26, 38.5%) were deemed unsuitable for rehabilitation in post-operative assessment compared to non-cancer MLA (21/236, 8.9%) patients, P < .001. There was a variation in destinations of discharge, with a greater proportion of cancer-MLA patients (4/26, 15.4%) going to a nursing home compared to non-cancer MLA (10/236, 4.2%) patients, P = .016.
Conclusion: Cancer is prevalent among vascular amputees, with a large proportion being occult diagnoses. Cancer is associated with poorer outcomes following amputation, but survival remains significantly better compared to palliation in cancer patients presenting with unsalvageable limbs.
{"title":"Amputation of the Unsalvageable Leg in Vascular Patients with Cancer.","authors":"Arsalan Wafi, Vijay Kolli, Bilal Azhar, Grace Poole, James Budge, Paul Moxey, Ian Loftus, Peter Holt","doi":"10.1177/15385744231171752","DOIUrl":"10.1177/15385744231171752","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare outcomes of major lower limb amputation (MLA) in patients with and without cancer and with cancer patients receiving palliation over amputation for their unsalvageable limb.</p><p><strong>Methods: </strong>Cancer patients who underwent a major amputation or palliation between 2013 and 2018 were included. Comparison groups were cancer-MLA (active/managed cancers), non-cancer MLA (historic cancer or no cancer history) and cancer-palliation at presentation with unsalvageable limbs. Prospectively collected data was retrospectively analysed for outcomes including survival, postoperative complications, length of stay, suitability for rehabilitation and discharge destination.</p><p><strong>Results: </strong>262 (cancer and non-cancer) patients underwent MLA and 18 patients with cancer received palliation. Of those amputated, 26 (9.9%) had active or managed cancer, of which 12 were diagnosed in the 6 months before MLA. Cancer-MLA patients presented with more acute ischaemia compared to non-cancer patients. Median survival was significantly different between the cancer-MLA (14.1 [9.5 - 29.5, 95% CI] months), non-cancer MLA (57.7 [45 - 73.6, 95% CI] months) and cancer-palliation (.6 [.4 - 2.3, 95% CI] months) groups, P < .001. A significantly higher proportion of cancer-MLA patients (10/26, 38.5%) were deemed unsuitable for rehabilitation in post-operative assessment compared to non-cancer MLA (21/236, 8.9%) patients, P < .001. There was a variation in destinations of discharge, with a greater proportion of cancer-MLA patients (4/26, 15.4%) going to a nursing home compared to non-cancer MLA (10/236, 4.2%) patients, P = .016.</p><p><strong>Conclusion: </strong>Cancer is prevalent among vascular amputees, with a large proportion being occult diagnoses. Cancer is associated with poorer outcomes following amputation, but survival remains significantly better compared to palliation in cancer patients presenting with unsalvageable limbs.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9673692","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 : 2023-08-01DOI: 10.1177/15385744231162924
Colum Keohane, Daniel Westby, Fiona C Nolan, Mark Twyford, Wael Tawfick, Stewart R Walsh
Background: The use of Hyperbaric Oxygen Therapy (HBOT) in diabetic wounds has been studied extensively. Even though venous insufficiency is the most common cause of lower limb ulceration, there is comparatively little evidence regarding the use of HBOT for Venous Leg Ulcers (VLU). We performed a systematic-review to evaluate and synthesise available evidence, to evaluate whether patients with VLU, when treated with HBOT, had greater rates of (i) complete VLU healing or (ii) reduction in VLU area, than controls.
Methods: In keeping with PRISMA guidelines, database searches of PubMed, Scopus and Embase was performed. After removal of duplicates, titles were screened for relevance by two authors, then abstracts, and in turn full text manuscripts. Data were extracted from relevant sources including one published abstract. Included studies were assessed for risk of bias using the Risk of Bias 2 (RoB-2) and Risk Of Bias In Nonrandomized Studies (ROBINS-I) tools.
Results: Six studies were included. There was significant heterogeneity across the studies, with no standard control intervention, method of outcome reporting, or duration of follow up. Two studies reported 12 week follow up results and pooled analysis of complete ulcer healing showed no statistically significant difference between HBOT and controls for the outcome of complete ulcer healing OR 1.54 (95%CI = .50-4.75) P = .4478. A similar non-signifiacnt result was seen in four studies reporting 5-6 week follow up; OR 5.39 (95%CI = .57-259.57) P = .1136. Change in VLU area was reported in all studies, and pooled standardised mean difference was 1.70 (95%CI = .60 to 2.79) P = .0024, indicating a statistically significant benefit of HBOT in reducing ulcer area.
Conclusion: Existing evidence suggests that HBOT does not significantly affect complete healing of VLU. There is a statistically significant benefit in terms of reducing ulcer size, though in the absence of ulcer healing the clinical significance of this is not established. Current evidence does not justify widespread use of HBOT for VLU.
背景:高压氧治疗(HBOT)在糖尿病创面中的应用已被广泛研究。尽管静脉功能不全是下肢溃疡最常见的原因,但关于使用HBOT治疗下肢静脉性溃疡(VLU)的证据相对较少。我们进行了一项系统回顾来评估和综合现有证据,以评估使用HBOT治疗的VLU患者是否比对照组具有更高的(i) VLU完全愈合率或(ii) VLU面积缩小率。方法:按照PRISMA指南,检索PubMed、Scopus和Embase数据库。在删除重复后,由两位作者筛选标题的相关性,然后是摘要,然后是全文手稿。数据摘自相关来源,包括一篇已发表的摘要。使用2号偏倚风险(rob2)和1号非随机研究偏倚风险(robins - 1)工具评估纳入研究的偏倚风险。结果:纳入6项研究。这些研究存在显著的异质性,没有标准对照干预、结果报告方法或随访时间。两项研究报告了12周的随访结果和溃疡完全愈合的汇总分析,结果显示HBOT与对照组之间溃疡完全愈合的结果OR为1.54 (95%CI = 0.50 -4.75) P = 0.4478,差异无统计学意义。在4项报告5-6周随访的研究中也发现了类似的无显著性结果;或5.39 (95%ci = 0.57 -259.57) p = 0.1136。所有研究均报告了VLU面积的变化,合并标准化平均差异为1.70 (95%CI = 0.60 ~ 2.79) P = 0.0024,表明HBOT在减少溃疡面积方面具有统计学意义。结论:已有证据表明HBOT对VLU的完全愈合无明显影响。在减少溃疡大小方面有统计学上显著的益处,尽管在没有溃疡愈合的情况下,其临床意义尚未确定。目前的证据并不能证明HBOT在VLU中的广泛应用。
{"title":"Hyperbaric Oxygen as an Adjunct in the Treatment of Venous Ulcers: A Systematic Review.","authors":"Colum Keohane, Daniel Westby, Fiona C Nolan, Mark Twyford, Wael Tawfick, Stewart R Walsh","doi":"10.1177/15385744231162924","DOIUrl":"https://doi.org/10.1177/15385744231162924","url":null,"abstract":"<p><strong>Background: </strong>The use of Hyperbaric Oxygen Therapy (HBOT) in diabetic wounds has been studied extensively. Even though venous insufficiency is the most common cause of lower limb ulceration, there is comparatively little evidence regarding the use of HBOT for Venous Leg Ulcers (VLU). We performed a systematic-review to evaluate and synthesise available evidence, to evaluate whether patients with VLU, when treated with HBOT, had greater rates of (i) complete VLU healing or (ii) reduction in VLU area, than controls.</p><p><strong>Methods: </strong>In keeping with PRISMA guidelines, database searches of PubMed, Scopus and Embase was performed. After removal of duplicates, titles were screened for relevance by two authors, then abstracts, and in turn full text manuscripts. Data were extracted from relevant sources including one published abstract. Included studies were assessed for risk of bias using the Risk of Bias 2 (RoB-2) and Risk Of Bias In Nonrandomized Studies (ROBINS-I) tools.</p><p><strong>Results: </strong>Six studies were included. There was significant heterogeneity across the studies, with no standard control intervention, method of outcome reporting, or duration of follow up. Two studies reported 12 week follow up results and pooled analysis of complete ulcer healing showed no statistically significant difference between HBOT and controls for the outcome of complete ulcer healing OR 1.54 (95%CI = .50-4.75) P = .4478. A similar non-signifiacnt result was seen in four studies reporting 5-6 week follow up; OR 5.39 (95%CI = .57-259.57) P = .1136. Change in VLU area was reported in all studies, and pooled standardised mean difference was 1.70 (95%CI = .60 to 2.79) P = .0024, indicating a statistically significant benefit of HBOT in reducing ulcer area.</p><p><strong>Conclusion: </strong>Existing evidence suggests that HBOT does not significantly affect complete healing of VLU. There is a statistically significant benefit in terms of reducing ulcer size, though in the absence of ulcer healing the clinical significance of this is not established. Current evidence does not justify widespread use of HBOT for VLU.</p>","PeriodicalId":23530,"journal":{"name":"Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10291374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10081643","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}