Vascular最新文献

BackgroundLower extremity amputations (LEA) are serious complications of the infected diabetic foot. Subsequent amputations are underreported and the occurrence of an ipsilateral second re-amputation (third amputation) is unknown.MethodsThis is a retrospective study of a continuous series of patients admitted for LEA due to diabetic foot complications, with a minimum of 2 years of follow-up after the first re-amputation. A total of 111 patients comprising 149 index amputation; 97 and 52 cases in the minor and major type groups, respectively. The primary outcomes were the observed frequencies of first and second re-amputations with comparative analysis based on amputation type. Logistic regression analysis was used to look for independent risk factors.ResultsOut of 149 index LEA cases, 111 cases (74.5%) had no re-amputation. First re-amputation frequencies were 25.5%, 35%, and 7.7% for the whole sample, minor, and major groups, respectively. Second re-amputation frequencies were 34.2%, 31.6%, and 2.6% for the whole sample, minor, and major groups, respectively. Infection re-occurrence was the cause in 89.5% and 100% of cases for first and second re-amputation. Out of the 13 second re-amputation cases in the minor group, 30.7% were minor and 69.3% were major amputations. The mean time for the first re-amputation was 5.4 ± 9.4 months and that for the second re-amputation was 9.5 ± 7.1 months (p = .04). For the first re-amputation, independent risk factors were smoking (p = .04) and creatinine level (p = .02) outcome. For the second re-amputation outcome, male sex was the only independent variable (p = .03).ConclusionThis study demonstrated that a second re-amputation, mostly major, was needed in more than one-third among first re-amputation cases. Second re-amputation could be a relevant major endpoint outcome in this frail population.

ObjectivesChronic venous insufficiency (CVI) is a prevalent condition with significant socioeconomic implications. Endovenous radiofrequency ablation (RFA) is a minimally invasive treatment option that has gained widespread acceptance due to its high efficacy and low complication rates. This study aimed to investigate the effectiveness of a novel venous access technique using a subcutaneous side branch of the greater saphenous vein (GSV) and compare it to the conventional direct GSV access technique.MethodsA total of 211 patients (288 legs) with CVI were randomly assigned to either the conventional access group (group 1, 145 legs) or the subcutaneous side branch group (group 2, 143 legs). Patients were assessed for demographic characteristics, venous access success rates, complications, and clinical outcomes. The primary outcomes were venous access success and procedural time, while secondary outcomes included complication rates such as vasospasm, ecchymosis, and thrombophlebitis.ResultsThe mean access time was significantly lower in group 2 (30.8 ± 9.9 seconds) compared to group 1 (46.7 ± 14.9 s) (p < 0.001). Additionally, group 2 required fewer cannulation attempts (1.28 ± 0.5) than group 1 (2.2 ± 0.9) (p < 0.001). Vasospasm occurred less frequently in group 2 (3.1%) than in group 1 (5.2%) (p = 0.005), and group 2 had significantly lower rates of ecchymosis (p = 0.033), thrombophlebitis (p = 0.026), and paresthesia (p = 0.045). No significant differences were observed between the groups regarding thermal skin injury (p = 0.142) or GSV occlusion rates at 3 months.ConclusionsThis study demonstrates that accessing the GSV via a subcutaneous side branch is a feasible and advantageous technique, leading to faster cannulation and reduced complication rates compared to the conventional approach. Further research is warranted to assess this novel technique's long-term outcomes and potential benefits in diverse clinical settings.

ObjectivesChronic venous disease (CVD) commonly presents as varicose veins, affecting a significant proportion of the population. Current treatments vary from invasive surgeries to advanced minimally invasive techniques, but many involve high costs and risk of complications. This study aimed to introduce and evaluate a novel, cost-effective technique combining high ligation of the great saphenous vein (GSV) with foam sclerotherapy, designed to minimize invasiveness, reduce complications, and improve patient outcomes.MethodsThe procedure began with ultrasound-guided mapping and marking of the GSV and perforating veins. Under local anesthesia, two small micro-incisions were created on the medial side of the leg. A double ligation was performed at the saphenofemoral junction using a 2-0 PDS suture, ensuring complete vein closure. Subsequently, the angiocatheters were inserted into the GSV above the perforators or in the mid-section of the vein if no perforators were present. Foam sclerotherapy was administered using a mixture of sodium tetradecyl sulfate, normal saline, and air. Compression bandaging was applied from the lower leg upward postoperatively. 18 patients were treated with this technique and followed up at 2 weeks, 3 months, and 6 months to assess clinical outcomes, complications, and recurrence.Results and ConclusionsThe novel technique demonstrated satisfied clinical outcomes with no reported complications, such as ecchymosis, hematoma, or discomfort, at the 2-week follow-up. No deep vein thrombosis (DVT) or recurrence cases were observed at the 3- and 6-month follow-ups. Our method reduced postoperative discomfort, bruising, and recovery time compared to traditional high ligation with stripping. Patients reported high satisfaction due to the minimally invasive nature and improved cosmetic results. Compared to thermal ablation methods, the technique was similarly effective but offered notable advantages in cost-effectiveness and accessibility, as it eliminated the need for expensive equipment or anesthesia. Future studies with larger sample sizes and extended follow-up periods are needed to validate these findings further, explore long-term recurrence rates, and refine patient selection criteria. This approach represents a promising, practical alternative for varicose vein treatment in diverse clinical settings.

ObjectiveTo assess the risk factors for varicose veins in patients under the age of 40 and the long-term results of surgery.MethodsThis multicenter case-control study comprised patients who received great saphenous vein stripping and ambulatory phlebectomy between January 2014 and December 2015 and were followed for at least 5 years. Patients under the age of 40 were assigned to Group 1. Patients in Group 2 were selected in a 3:1 ratio by matching their CEAP classification to those in Group 1. We studied their demographics, risk factors, and follow-up findings.ResultsThere were 42 patients (mean age 35) in Group 1 and 126 patients (mean age 57) in Group 2. Group 2 patients had a higher prevalence of hypertension (16% vs 2%, p = .022). The proportions of C2, C3, C4, C5, and C6 were 52%, 10%, 24%, 10%, and 5%, respectively. For risk factors, only family history was more prevalent in Group 1 (odds ratio 4.9, 95% confidence interval 2.3-10.4). The course of the disease was shorter in Group 1 (p = .003). During a mean follow-up of 79 months, there were no difference in the recurrences of varicose vein, Venous Clinical Severity Score, or Aberdeen Varicose Vein Questionnaire scores (p > .05), which indicated similar 5-year surgery efficacy between the two groups.ConclusionFamily history was more prevalent and the course of the disease was shorter among young patients with varicose veins. The 5-year prognosis of surgery was satisfactory despite the age of receiving the treatment.

BackgroundAtherosclerosis in carotid arteries can lead to carotid stenosis, where carotid endarterectomy (CEA) is the first-line intervention. Malignancy has a two-way relationship with atherosclerosis, where they share common molecular pathways in their pathophysiology. However, the postoperative outcomes of CEA in patients with disseminated cancer remain unclear. This study aimed to examine the 30-day outcomes of CEA in patients with disseminated cancer.MethodsPatients with and without disseminated cancer who underwent CEA were identified in the ACS-NSQIP targeted database from 2011 to 2022. Patients with age <18 years were excluded. A 1:5 propensity-score matching was used to address preoperative differences between the cohorts. Thirty postoperative outcomes were examined.ResultsThere were 148 (0.37%) patients with disseminated cancer who went under CEA. Meanwhile, 40,028 patients without disseminated cancer underwent CEA, where 740 of them were matched to those with disseminated cancer. After 1:5 propensity-score matching, disseminated cancer patients had higher risks of 30-day mortality (4.73% vs 1.62%, p = .03), and deep vein thrombosis (3.38% vs 0.68%, p = .01), while stroke, transient ischemic attacks, and other 30-day outcomes were comparable between the groups.ConclusionPatients with disseminated cancer had higher thromboembolism and mortality after CEA. Given the prevalence of cancer-related thrombosis and its associated increased mortality risk, effective prophylaxis and treatment for venous thromboembolism, such as low molecular weight heparin administration, should be essential in patients with disseminated cancer. These findings can also be valuable for preoperative risk stratification and in determining the surgical candidacy of patients with disseminated cancer in CEA. CEA for asymptomatic patients with disseminated cancer may require further justification given their elevated perioperative risk.

IntroductionArteriovenous fistula (AVF) is the preferred method for vascular access. However, fistulas can fail and may develop stenosis. Therefore, maintaining the patency of the access is vital. Balloon angioplasty has been accepted as the first-line treatment for central venous stenosis. However, the reintervention rate with plain balloon angioplasty (PBA) is high. Drug-coated balloons (DCB) have emerged as a promising therapy for effectively prolonging the patency of treated vessels and reducing the reintervention rate. This study aims to determine the 12-month patency of arteriovenous fistulas following paclitaxel-coated balloon (PCB) angioplasty for central and peripheral venous stenosis.MethodsThis single-center retrospective analysis included patients with end-stage renal disease who underwent hemodialysis via native arteriovenous fistulas. The information was collected from medical records and compiled into a de-identified database provided by the institution. All patients were included regardless of sex or age, provided they had an angiography demonstrating central or peripheral venous stenosis and were treated with PCB. Patients were followed up every 3 months for 12 months at the vascular center. The primary objective was to ensure the vascular access was functioning effectively for hemodialysis and to monitor for any complications.ResultsA total of 137 patients with AVF dysfunction were treated with PCB; among them, 111 (81%) had central venous stenosis and 26 (19%) had peripheral venous stenosis. There was no significant difference in patency rates at 12-month follow-up between central (79%) and peripheral (85%) accesses. Factors associated with non-patency at 12-month follow-up were exhausted access (HR = 0.21, 95% IC 0.09-0.47, p < .001) and stenosis length greater than 20 mm (HR = 0.33, 95% IC 0.15-0.72, p = .005).ConclusionsThe high patency rate at 12 months for dysfunctional AVFs indicated that treatment with PCB is highly effective in both central and peripheral vein stenosis.

ObjectivesThe aim of this study was to evaluate the one-year results of the Eluvia drug-eluting vascular stent (Boston Scientific, Marlborough, MA, USA) for the treatment of femoropopliteal occlusive disease (FPOD).MethodsFrom January 2021 to November 2023, this multicenter study prospectively enrolled patients with peripheral artery disease involving the femoropopliteal artery. The primary outcome measures were the rate of freedom from clinically driven target limb revascularization (f-CD-TLR), rate of freedom from major adverse events (f-MAE), rate of freedom from symptom recurrence (f-SR) and rate of freedom from all-cause death (f-ACD). The secondary outcome measures were the Rutherford grade and Vascular Quality of Life (VascuQoL) scale scores.ResultsIn total, 159 patients were enrolled in this study. The mean follow-up time was 370 days, and the follow-up rate was 83.0%. The patients' mean age was 72 years, and 82.4% were male. A total of 159 patients received 199 stent deployments. The mean lesion length was 194.4 ± 118.9 mm, and 76.7% had total occlusions. The technical success rate for endovascular treatment was 100%, and five complications occurred during the perioperative period. At one, three, six, and 12 months, the f-CD-TLR rate was 99.3%, 97.9%, 96.4%, and 92.8%, respectively; the f-MAE rate was 98.0%, 96.7%, 93.1%, and 91.3%, respectively; the f-SR rate was 94.6%, 85.5%, 80.3%, and 73.4%, respectively; and the f-ACD rate was 98.0%, 98.0%, 95.9% and 94.1%, respectively. There was a substantial increase in the Rutherford grade and average VascuQoL scores at the one-, three-, six-, and 12-month follow-ups (p < .001).ConclusionsThe Eluvia stent had a favorable effect on FPOD throughout 12 months of follow-up. Further studies with larger sample sizes and longer-term follow-up are required to confirm the real-world performance of the Eluvia stent.

ObjectivePhotoplethysmography provides information about global venous function and is also used to assess the time required to refill the veins within the dermis or the venous refill time. This descriptive cross-sectional study aims to investigate the relationship between pain, quality of life, and venous refill time in patients with chronic venous insufficiency.MethodsThe study was conducted on a sample of 72 patients diagnosed with chronic venous insufficiency. Data were collected using the Descriptive Characteristics Form, the Short-Form McGill Pain Questionnaire, and the Venous Insufficiency Epidemiological and Economic Study: The Quality of Life/Symptoms Scale (VEINES-QOL/Sym), and venous refill time was obtained by using photoplethysmography.ResultsThe mean age of the patients included in the study was 41.24 ± 13.58 years, and 54.2% were female. A positive correlation was found between photoplethysmography and VEINES-QOL/Sym, whereas a negative correlation was found with the McGill Pain Questionnaire (p < .001). The results showed that photoplethysmography significantly predicted VEINES-QOL/Sym and McGill Pain Questionnaire with a statistically significant correlation (p < .001).ConclusionsThe results of this study indicate that venous refill time has a significant impact on both pain and quality of life. The findings underscore the need to mitigate the negative impact of CVI on quality of life in patients diagnosed with CVI. In this regard, it is of great importance to identify the factors that negatively affect the quality of life of patients with CVI and to provide counseling services for these factors.

ObjectiveTo compare outcomes between patients who underwent preoperative non-invasive testing and those who did not prior to all-level lower extremity amputation (LEA).MethodsA retrospective analysis of patients undergoing LEA between April 1st 2019 and June 30th 2023 at an acute care facility was performed and relevant demographic and perioperative data collected. The primary endpoint was the association of preoperative non-invasive testing on MALE and MACE.Results188 patients who underwent all-level LEA were included and stratified into two groups: those who had preoperative non-invasive testing (52.7%; n = 99; p < .01) and those who did not (Groups A and B, respectively). Group A demonstrated higher minority representation (p = .04), pre-existing vascular disease (p < .01), hypertension (p < .01), and renal and cardiac comorbidities (both p < .01).Chi-squared analysis between groups demonstrated no significant difference in all-level LEA for outcomes of postoperative revascularization (p = .63), re-amputation (major or all-level; p = .98 and p = .78, respectively), nor any differences in wound complications (p = .79) or mortality (p = .37). In sub-analyses for major and minor amputations, there remained no significant differences in major re-amputation (p = .69 and p = .27, respectively), 30-day wound complications (p = .44 and p = .65, respectively), or MACE (p = .50 and p = .93, respectively) between groups.ConclusionsAuthors note infrequent use of non-invasive testing prior to LEA, and similar MALE and MACE outcomes between groups with potential benefit in medically vulnerable cohorts. With a lack of established guidelines on preoperative workup prior to LEA, additional prospective studies with matched cohorts and similar endpoints may promote algorithms to optimize perioperative outcomes.

ObjectiveCarotid artery stenting is a minimally invasive procedure often chosen to treat carotid artery stenosis. In-stent restenosis is a well-known complication of this procedure. Statins, primarily recognized for their role in lowering LDL cholesterol, have been demonstrated to reduce in-stent restenosis following coronary artery stenting. This effect is often attributed to their pleiotropic properties rather than solely their impact on LDL cholesterol. Given that neointimal hyperplasia is the mechanism underlying in-stent restenosis in both coronary and carotid artery stenting, this study aims to investigate the effects of statins on in-stent restenosis in patients undergoing carotid artery stenting, as well as to identify factors that contribute to restenosis.MethodsThe study included 51 patients who underwent carotid artery stenting. Data collected included the patients' age, gender, presence of hypertension, diabetes mellitus, hyperlipidemia, smoking history, post-procedure smoking, statin use, plaque morphologies, and Doppler and NASCET stenosis rates. Follow-ups were performed at 3rd and 6th months post-procedure. Maximum LDL cholesterol levels and HbA1c levels were measured at the 6-month follow-up. Intima-media thickness within the stent lumen was assessed, and restenosis was evaluated based on spectral Doppler findings.ResultsIn our study, according to the measurements obtained from the in-stent segment, restenosis was detected in 5 patients (9.8%) overall. After the procedure, 37 patients (72.5%) were on statins, while 14 (27.5%) were not. Restenosis occurred in 4 patients (28.6%) in the non-statin group and 1 patient (2.7%) in the statin group, with a statistically significant difference (p = .017). All patients in the non-statin group had maximum LDL cholesterol levels ≥100 mg/dl during the follow-up. In the statin group, 67.6% of patients had maximum LDL cholesterol levels ≥100 mg/dl, while 32.4% of patients had <100 mg/dl. The difference was found statistically significant (p = .022). All 5 patients who developed restenosis had left-sided stents, and the difference between the groups was found to be close to statistical significance (p = .051). No significant differences were found between groups concerning other factors influencing restenosis and neointimal hyperplasia (p > .05).ConclusionsOur study is the first in the literature to demonstrate that statin use is effective in preventing the development of restenosis in patients who underwent carotid artery stenting. This effect appears to occur independently of LDL cholesterol levels and is attributed to the pleiotropic effects of statins. Based on the data obtained, we believe that statin use after the procedure may reduce restenosis rates, regardless of LDL cholesterol levels.