Vascular最新文献

ObjectivesCarotid artery dissection (CAD) is a significant cause of strokes in young individuals, leading to severe complications and socioeconomic burdens. Despite antithrombotic therapy being the primary management strategy, optimal treatment for patients with recurrent or worsening symptoms remains undefined. This study aims to describe the characteristics and evaluate the outcomes of conservative versus surgical management in CAD patients.MethodsA total of 23 patients presenting with CAD from November 2014 to December 2021 were reviewed retrospectively. Patient demographics, vascular risk factors, symptoms, imaging results, treatment details, and follow-up information were collected and analyzed. Propensity score matching (PSM) was utilized to enhance comparability.ResultsThe mean age of the patients was 46.4 ± 9.4 years, with a median follow-up of 12 (range 3-90) months. Of the 23 patients reviewed, seven underwent endovascular treatment or open surgery due to unresponsiveness to conservative therapy, while 16 received conservative management. All patients showed regression of symptoms. Surgical patients showed a significant improvement with a 100% patency rate during the follow-up. PS matching adjusted for baseline differences, yielding comparable groups for analysis. No significant difference between treatment approaches was observed in stroke recurrence rates, although surgical intervention showed promising outcomes in symptom resolution and stroke prevention.ConclusionBoth conservative and surgical management of CAD can lead to favorable outcomes. While conservative therapy remains the initial approach and proves effective, surgery appears beneficial and safe in certain cases unresponsive to conservative treatment. Further investigation through larger prospective and randomized trials is necessary to establish its safety and efficacy.

ObjectivesPeripheral arterial disease (PAD) and coronary artery disease (CAD) are major contributors to global morbidity and mortality. Many PAD patients remain asymptomatic for CAD, which often leads to undetected coronary artery involvement. This hidden coronary disease poses significant risks, particularly following peripheral revascularization, as increased cardiac demand can precipitate complications.MethodsThis cross-sectional descriptive study assessed the prevalence of coronary artery stenosis in patients with Fontaine Stage IV peripheral arterial disease. Simultaneous angiography of both the coronary and lower extremity arteries was performed, and the severity of arterial stenosis was rigorously evaluated. The correlation between the extent of peripheral and coronary artery disease was analyzed.ResultsA total of 60 patients (63.3% male, 36.7% female; mean age 65.23 ± 9.86 years) were included. Comorbidities were common, with 90% having diabetes, 50% hypertension, 23.3% hyperlipidemia, and 30% smoking history. Severe peripheral artery stenosis was frequently observed, particularly in the posterior tibial artery (total occlusion in 26.6% and 20% of the right and left arteries, respectively). Significant coronary involvement was also prevalent, with 51.7% exhibiting three-vessel disease. Coronary revascularization was required in the majority of cases (CABG: 40%, PCI: 35%), with a higher proportion among women (77.2%) and men (73.7%).ConclusionThis study highlights the necessity of comprehensive coronary evaluation in patients with advanced lower limb ischemia. A substantial proportion of these patients have silent but critical coronary disease, which, if left unaddressed, could result in serious post-revascularization complications.

ObjectiveThe study aimed to investigate the reliability of a portable toe pressure (TP) photoplethysmography device (PPG) by comparing it to a stationary laser Doppler flowmeter (LD) used in the Helsinki University Hospital. The study evaluated if lower limb arterial circulation could be reliably evaluated with the portable PPG which is more affordable and mobile than the stationary LD.MethodsTPs were measured from 102 toes of 54 patients in the vascular surgery outpatient clinic, vascular surgery ward and interventional radiology recovery ward of Helsinki University Hospital. According to the study protocol TPs were measured twice with the PPG device. If the difference between the values was over 10 mmHg, a third measurement was done and two of the closest values were selected for the final analysis. The lowest value displayed by the PPG device was 30 mmHg. Lower than 30 mmHg values were reported as 25 mmHg in the analysis. The repeatability and reliability of the PPG measurements were compared to the LD with Bland Altman plots.ResultsMost patients had rest pain (n = 29) or claudication (n = 9). Prior to TP measurement, 24 patients had undergone lower limb revascularization through either a hybrid (n = 3), open (n = 10) or endovascular (n = 11) procedure. The mean absolute difference between PPG and LD measurement values was 15 mmHg (95% confidence interval 12-18 mmHg). 87.5% of lower limbs with significant arterial insufficiency (TP <60 mmHg with LD, n = 49) had a PPG measurement value of <60 mmHg. Conversely, 84.8% of lower limbs that did not exceed the ischemia criterion of TP ≥60 mmHg with LD had a PPG measurement value of ≥60 mmHg. Mean absolute difference of two consecutive PPG measurement values was 4 mmHg (95% CI 3-5 mmHg).ConclusionsThe PPG device is a light and affordable option for the assessment of lower limb arterial circulation in primary health care. It is moderately reliable to exclude significant lower limb arterial insufficiency and may reduce unnecessary referrals to the vascular surgery clinic. The repeatability of the PPG device is satisfactory. However, it requires training to use, and the results must always be interpreted with consideration for the patient's clinical status.

ObjectivesThe study aims to evaluate the safety and efficacy of the BeBack™ crossing catheter for percutaneous recanalization of lower limb chronic total occlusions (CTO) via tibial artery access in patients with chronic limb-threatening ischemia (CLTI).MethodsThis single-center, retrospective study included 21 patients who underwent 22 limb recanalization procedures between May 2021 and April 2024. The BeBack™ catheter was utilized after traditional methods of recanalization failed. Patients aged 18 years or older with peripheral artery disease (PAD) and treated exclusively through the tibialis anterior artery were included. Data on demographics, occlusion characteristics, procedural details, and outcomes were collected from hospital records. Procedural success was defined as achieving less than 30% residual stenosis and an improvement in the ankle-brachial index (ABI) by at least 0.2 within 24 h.ResultsThe median patient age was 77 years (IQR 73-81.5), with the majority being male (71%). Technical success was achieved in 95% of cases (21/22), and procedural success was achieved in 91% (20/22) cases. The device was primarily used for re-entry (77%), with a minority of cases (23%) where it was used as a crossing device. The most frequently treated artery was the superficial femoral artery (95%). One procedural failure was noted due to an inability to traverse a heavily calcified occlusion. Complications included one case of intra-procedural acute thrombosis, which was resolved, and one instance of post-procedural pulmonary edema, treated with diuretics. No reinterventions or amputations were required during the 30-day follow-up, although there were three mortalities (14%).ConclusionsThe BeBack™ crossing catheter demonstrated high technical success and a low complication rate for recanalizing lower limb CTOs via a single tibial artery access. These findings suggest that the BeBack™ catheter could be an effective and safe option for managing complex CTOs, particularly when traditional approaches are not feasible. Further prospective studies are needed to validate these results and compare them with other crossing and re-entry devices.

ObjectiveCollateral vessels develop from pre-existing arterioles in response to shear stress from arterial stenosis and mechanosensor activation. Animal studies suggest that these vessels increase in number and size after arterial occlusion, potentially offering a natural bypass and protection against critical limb ischemia. Efforts to enhance collateral vessel growth aim to improve walking performance in peripheral arterial disease (PAD). Factors influencing collateral vessel formation include plaque accumulation, tissue components, and comorbid conditions. Balloon angioplasty is a primary treatment for PAD but often leads to vessel dissection, with severe dissections linked to reduced long-term patency and requiring additional treatments. The relationship between collateral vessel characteristics and dissection severity remains unexplored.Materials and MethodsThis retrospective study analyzed endovascular treatments for femoropopliteal chronic total occlusion (FP-CTO) in 824 limbs of 706 PAD patients from January 2018 to May 2023. Exclusion criteria included prior treatments, severe aortoiliac and common femoral artery disease, and deep femoral artery disease. The final cohort comprised 410 limbs from 387 patients. Data on risk factors, lesion characteristics, and procedural details were collected. Collateral vessels were assessed by grade and number, and vessel dissection was categorized from Type A to Type F. Multivariate logistic regression identified predictors of severe dissection.ResultsSevere dissection was more frequent in TASC II C/D lesions and in patients with longer FP-CTO lengths, CTOP class-4 plaque morphology, flush ostial CTO, severe calcification, and large or numerous collateral vessels. Significant predictors of severe dissection included end-stage renal disease, FP-CTO length, CTOP class-4, flush ostial CTO, severe calcification, and large collateral vessels.ConclusionLonger CTO lengths and complex plaque characteristics increase the risk of severe dissection during balloon angioplasty. Large and numerous collateral vessels are associated with severe dissection. Severe dissection is more common in complex lesions and those with end-stage renal disease. The findings suggest that plaque compliance and collateral vessel characteristics are crucial in assessing dissection risk, highlighting the need for further research with larger cohorts and advanced imaging techniques.

BackgroundThoracic Endovascular Aortic Repair (TEVAR) has revolutionized the surgical treatment for Stanford type B aortic dissection (TBAD). While chronic obstructive pulmonary disease (COPD) is associated with worse outcomes in major surgeries, the specific outcomes of TEVAR in patients with COPD have not been extensively explored. This study aimed to evaluate the 30-day postoperative outcomes of COPD patients undergoing TEVAR for TBAD utilizing data from a multi-institutional national registry.MethodsPatients who underwent TEVAR for TBAD were identified in the ACS-NSQIP database from 2005 to 2022. A 1:3 propensity-score matching was used to match demographics and preoperative characteristics between patients with and without COPD. Thirty-day postoperative outcomes were compared.ResultsThere were 172 (9.56%) and 1628 (90.44%) COPD and non-COPD patients who underwent TEVAR for TBAD, respectively. Patients with COPD had a higher comorbidity burden. After the propensity-score matching, all 172 COPD patients were matched to 440 non-COPD patients. COPD and non-COPD patients had comparable mortality rates (10.12% vs 6.82%, p = .18). However, COPD patients had a higher risk of pulmonary complications (20.83% vs 13.18%, p = .02). All other 30-day outcomes were similar between the two groups.ConclusionCOPD patients had 58.04% higher pulmonary complications while all other 30-day outcomes were comparable to their non-COPD counterparts. Therefore, close monitoring and timely intervention for pulmonary complications in COPD patients can be important after TEVAR for TBAD. Future studies should investigate long-term outcomes among these COPD patients.

ObjectivesPost-reperfusion compartment syndrome is an emergency consequence following revascularization of acute limb ischemia. Fasciotomy is the gold standard treatment for acute compartment syndrome. Some surgeons perform prophylactic fasciotomy (PF) during the same operation; however, fasciotomy may lead to wound complications and an increased length of hospital stay. This study aims to evaluate the outcomes of prophylactic fasciotomy in our hospital.MethodsThis is a retrospective observational cohort study. We reviewed the data of acute limb ischemia patients at Maharaj Nakorn Chiangmai Hospital, who were diagnosed with non-traumatic acute limb ischemia and received revascularization between January 2006 and August 2022. The primary outcomes are 30-day amputation-free survival (AFS) and overall survival (OS). Propensity score weighting with confounder adjustment was used to balance peri-operative confounders.ResultsFrom our data, there were 56 patients in the PF group and 301 in the non-prophylactic fasciotomy (NPF) group. The 30-day amputation rates were 12.5% and 10% in the PF and NPF groups, respectively (p-value 0.895). The 30-day AFS was similar between the PF and NPF groups, with a hazard ratio (HR) of 0.93, 95% confidence interval (CI) 0.32-2.45, and a p-value of 0.882. The 30-day OS in the PF group was statistically lower than that in the NPF group, HR 4.09, 95% CI 1.55-10.77, and a p-value of 0.004. The 1-year and 5-year AFS were not significantly different between the PF and NPF groups. However, the 1-year and 5-year OS were lower in the PF group compared to the NPF group, with HR 3.44, 95% CI 1.37-8.65, and a p-value of 0.009, and HR 3.04, 95% CI 1.24-7.45, and a p-value of 0.015, respectively. Fasciotomy wound infection rates were higher in the PF group compared to the NPF group, 5.5% versus 1.7%, respectively, p-value 0.017. Other clinical outcomes did not show significant statistical differences.ConclusionsProphylactic fasciotomy may not improve amputation-free survival (AFS) but increases mortality, particularly within the first 30 days, even in some high-risk patients. The use of prophylactic fasciotomy should be limited to cases where it is clearly indicated.

ObjectivesThe aim of this study was to report 2-year outcomes of interwoven nitinol (Supera^TM) stent-assisted arteriovenous fistula (AVF) maturation in patients who presented with non-matured AVF.MethodsWe reviewed the clinical data of 20 patients who presented with non-matured AVF (19 patients with brachiocephalic AVF and 1 patient with radiocephalic AVF) and underwent balloon angioplasty followed by Supera^TM stenting in the cephalic vein for long-term hemodialysis between January 2017 and January 2022. The outcomes were evaluated in these patients in terms of technical success, post-intervention complications, reintervention, and cumulative patency (6 months, 1 year, and 2 years).ResultsThe study included 20 patients who presented with non-matured AVF. The mean age of the patients was 65 years (range, 40-85). The Supera^TM stents of size 6.5 mm were used in 15 patients (75%), and those of 7.5 mm and 5.5 mm were used in 4 (20%) and 1 (5%) patient, respectively. The average stent length was 99.5 mm (range, 80-120). Technical success was achieved in all patients. Early use within 1 week by needling at the Supera^TM stent segment (cannulation zone) was successful in all patients without any complications. The mean follow-up time was 24.5 months. During the follow-up period, reinterventions to maintain the function of AVF were performed in 8 patients (40%) (7 patients with juxta-anastomotic stenosis, 1 patient with in-stent restenosis). The reintervention rate was 0.39 procedures per patient per year. The primary patency at 6 months, 1 year, and 2 years were 85.5%, 62.6%, and 54.2%, respectively. The assisted primary patency at 6 months, 1 year, and 2 years were 95%, 84.5%, and 78.8%, respectively.ConclusionsThe use of the Supera^TM stent to improve the AVF maturation rate was associated with acceptable outcomes at 2 years. Its benefit over other strategies was the early use of the access for hemodialysis.