Vascular最新文献

Background: Vessel wall calcification is associated with stent under-expansion and in-stent restenosis. The traditional approaches to treat peripheral artery calcification are percutaneous transluminal angioplasty (PTA) and atherectomy. Shockwave intravascular lithotripsy (IVL) uses sonic wave pressure to disrupt calcium of the severely calcified lesions. Published reports of IVL to treat in-stent restenosis are limited to coronary interventions and bare metal platforms.

Methods: We describe the case of a 55-year-old male with extremely compressed under-expanded covered stents associated with severe wall calcification that resulted in stent occlusion.

Results: The IVL system balloon was deployed uneventfully, in a phased manner. Bilateral bare metal stents were also placed in a kissing fashion to further re-expand the arterial segments. Reintervention with IVL facilitated successful revascularization and the stent remained patent at 24 months.

Conclusion: Our case highlights the use of IVL as an effective tool in the management of vessel wall calcification both for primary and secondary interventions.

Objective: To evaluate the midterm results of patients with saccular aneurysms treated with the jailed coiling technique.

Methods: A retrospective review of 17 patients treated with the jailed coiling technique over a 7 year period, between 2018 and 2024 at our institution. Treatment entails placing an endograft across the neck of the saccular aneurysm followed by coiling of the aneurysm through an extraluminal catheter. Debranching procedures of the aortic arch were performed when necessary in order to create a sealing zone of >5 mm. Data collected included demographics, anatomical features of the lesions and sealing zones, indication for intervention, method of treatment and technical success, sac expansion, and reinterventions.

Results: 17 patients (median age 69, 14 males) were treated for saccular aneurysms with short, suboptimal sealing zones (aortic arch 13, distal thoracic aorta 2, celiac trunk 1, brachiocephalic artery 1). Among the aortic arch aneurysms, six required preoperative debranching procedures of the aortic arch in order to create a short landing zone of 5 mm, making them eligible for the procedure. Technical success was obtained in all patients. One perioperative mortality occurred. Mean follow-up among those treated for arch aneurysms was 32 months (range 1-71 months). One patient who was treated for an aortic arch aneurysm had a persistent endoleak. No sac enlargement was observed. None of the patients required interventions and none experienced aneurysm related mortality.

Conclusion: The jailed coiling technique is a safe and effective method to treat saccular arterial aneurysms with suboptimal, short sealing zones. It can be utilized for saccular aneurysms located within the aortic arch and for aneurysms located in other locations where coiling or stent grafting is not an option. The procedure can be performed with minimal morbidity with a high percentage of success. Long term durability of the repair needs to be determined.

Objective: This study aimed to investigate the safety and efficacy of a new Chinese device using microwave ablation for treating symptomatic great saphenous vein (GSV) varicose veins (VVs).

Methods: This prospective, single-arm, single-center, cohort study investigated the safety and efficacy of endovenous microwave ablation for the treatment of symptomatic VVs. A total of 50 patients with lower limb varicose veins were enrolled from the Hospital of Chengdu University of Traditional Chinese Medicine. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The primary outcome was the occlusion rate of GSV immediately and at 1, 6, and 12 months after the treatment. The secondary outcomes included the venous clinical severity score (VCSS), the chronic venous insufficiency questionnaire 14 items (CIVIQ-14) score, the Aberdeen varicose vein questionnaire (AVVQ) score, and the pain visual analog scale (VAS) score. This study protocol was registered at ClinicalTrials.gov (ID: NCT04645771).

Results: In total, 50 limbs from 50 patients (26 female; mean age: 53.45 ± 9.78 years) were treated. A technical success rate of 100% was achieved and no serious adverse events were recorded. During the follow-up period, the occlusion rate of the major/minor saphenous vein trunk remained 100% at 1, 6, and 12 months after surgery except one patient fell off. The median 24-h VAS value was 2 (2,3). The VCSS score, CIVIQ-14 score, and AVVQ score (p < .05) at 1, 6, and 12 months improved significantly compared with the value preoperative (p < .05).

Conclusion: EMA was safe and effective for treating varicose veins in the lower limbs, with a high rate of venous trunk occlusion and few complications, thus improving patients' postoperative quality of life.

Background: The minimally invasive procedures of venous ablation and iliac vein stenting are evolving treatment options for venous insufficiency. Yet, there are no studies directly comparing the outcome of these procedures. We performed a survey on patients who had both procedures, to determine if either procedure helped more and if there is any other clinical factor related to the outcome.

Method: We collected data between Jan 2012 and Feb 2019 from 726 patients who failed to improve swelling after conservative management. The patients underwent iliac vein stenting and vein ablations. We recorded patient assessment of the leg immediately after completion of both procedures. Follow-up was performed using in-person questionnaires by asking if improvement in lower extremity swelling occurred and if so, which procedure helped more.

Results: Of the 726 patients who underwent endovenous closure and iliac vein stent placement, 254 (35%) were males. The average age of the patients was 70 (±13.7 SD, range 29-103) years. The presenting symptom (C of CEAP classification) of lower extremity limb venous disease was 34.8%, 44.6%, 5.6%, and 15% for C3-C6, respectively. Patients were asked about swelling, and they stated: swelling is better (605, 83.3%), swelling is not better (118, 16.3%), and not sure if there is any improvement in swelling (3, 0.4%). Patients stated the following completion of both procedures: both procedures equally helped (129, 18%), iliac vein stent superior (167, 23%), endovenous ablation superior (177, 24%), neither helped (112, 16%), and not sure which procedure helped more (141, 19%). After ANOVA, we concluded that older patients (average = 72.5 years) were more often not sure which procedure helped more (p = .024), and younger patients (average = 68.4 years) stated that endovenous ablation helped more (p = .014). There were no significant differences between the groups regarding gender (p = .9), laterality (p = .33), or presenting symptoms scores (p = .9). There was no statistical relationship between the procedure that was performed first and the procedure that helped more (p = 0.095).

Conclusion: In this qualitative assessment, preliminary data suggest that the comparative role of iliac vein stent versus endovenous ablation warrants further study. The data were broadly distributed, and neither procedure was superior. In addition, 16% of the patients stated that neither procedure helped. The age of patients may also play a role in their procedure preferences and their subjective assessment for improvement.

Objective: This study aimed to identify predictors of iliac vein compression syndrome (IVCS) in patients with varicose veins and to evaluate the necessity of routine lower extremity venography for preoperative assessment of these patients.

Methods: A retrospective analysis was conducted on data from 1165 patients with lower-limb varicose veins who underwent preoperative venography at Wuhan Union Hospital, Tongji Medical College, China, between January 2019 and September 2023. Logistic regression analyses identified factors associated with concurrent IVCS, and a nomogram was constructed based on these findings.

Results: Out of 1165 patients, 75 (6.4%) had IVCS according to venography and 769 had iliac vein ultrasound and found 2 (0.17%) positives. Multivariate analysis revealed the independent predictive value of left-sided involvement (odds ratio (OR) = 3.22, 95% confidence interval (CI): 1.24-8.33, p = 0.016), history of deep vein thrombosis (DVT) in the affected limb (OR = 3.11, 95% CI: 1.21-8.00, p = 0.018), pain (OR = 2.24, 95% CI: 1.17-4.26, p = 0.014), and positive results on iliac vein ultrasound (OR = 25.56, 95% CI: 2.10-311.26, p = 0.011) for the presence of IVCS in patients with lower-limb varicose veins. A nomogram incorporating these predictors demonstrated moderate predictive ability (AUV = 0.689, 95% CI: 0.607-0.771), with good calibration upon validation.

Conclusions: Patients with left lower extremity varicose veins, pain symptoms, history of DVT in the affected limb, and positive iliac vein ultrasound findings are at a higher risk of concurrent IVCS. Patients with varicose veins who have the aforementioned risk factors may need to undergo preoperative angiography.

Objectives: This study aims to quantify changes in renal blood flow before and after endovascular aneurysm repair (EVAR) using four-dimensional (4D) flow magnetic resonance imaging (MRI) and evaluate its correlation with renal impairment.

Methods: In this retrospective analysis, 18 patients underwent elective EVAR for infrarenal fusiform abdominal aortic aneurysms using Excluder or Endurant endografts. 4D flow MRI scans were conducted before and 1-4 days after EVAR. Hemodynamics were quantified at the suprarenal aorta (SupAo), bilateral renal arteries (RRA and LRA), and infrarenal aorta (InfAo). Cardiac phase-resolved blood flow values (BFVs), relative flow distribution (RFD), and flow change rates (FCRs) were assessed. Estimated glomerular filtration rate (eGFR) was measured pre- and postoperatively.

Results: A total of 16 patients were analyzed after excluding two outliers. Pre-EVAR BFVs were 23.1 ± 8.3, 3.7 ± 1.3, 3.4 ± 1.2, and 15.1 ± 5.9 mL/cycle, while post-EVAR BFVs were 20.9 ± 6.9, 3.8 ± 1.1, 3.2 ± 0.9, and 12.1 ± 4.3 mL/cycle in SupAo, RRA, LRA, and InfAo, respectively. Comparing Excluder (N = 8) and Endurant (N = 8), the total renal FCR was 121.8% [106.6-144.7] versus 101.3% [63.8-121.8] (p = 0.110), suggesting a potential improvement in renal blood flow with the Excluder, although not statistically significant. A significant correlation was found between the total renal FCR and the relative eGFR at 6 months (Spearman correlation coefficient, 0.789; p < 0.001).

Conclusions: The endografts, particularly the Excluder, showed potential in improving renal artery blood flow in some patients. The significant correlation between the total renal FCR and the relative eGFR at 6 months suggests that acute hemodynamic alterations induced by EVAR may impact post-operative renal function. Further research is needed to confirm these findings and assess their clinical implications.

Objectives: Rotational atherectomy can offer a viable treatment for occlusive peripheral artery disease; maintaining the minimal invasiveness of an endovascular procedure, while allowing for a more complete lesion debridement compared with balloon angioplasty. This case report outlines a complication of guidewire entrapment associated with rotational atherectomy in the superficial femoral artery (SFA).

Methods: A 57-year-old male underwent an atherectomy with Rotorex for left lower limb foot pain. During the procedure, the guidewire was suctioned into the atherectomy device, preventing any further advancement of the device and damaging the SFA and posterior tibial artery (PTA).

Results: The atherectomy device was withdrawn and a new vascular access site was gained in the left PTA. A covered stent was inserted to treat the original SFA lesion, and balloon angioplasty was used to repair the device-induced damaged to the PTA.

Conclusion: While guidewire complications have been previously reported, this case report details the first reported case, to our knowledge, of guidewire entrapment while using a rotational atherectomy device. Knowledge of this possible complication of rotational atherectomy can aid in clinical decision making when choosing between treatments for peripheral vascular disease.

Objective: The survey aimed to evaluate the precise roles and importance of carotid plaque thickness and carotid intima-media thickness measured in plaque-free areas (PF CC-IMTmean) in future cardiovascular risk prediction.

Material and methods: 188 respondents between the age of 46 and 87 divided into two groups (I group - 94 respondents without plaques with CIMT measurement and II Group 94 respondents with carotid plaques; 118 men and 70 women; mean age ± SD, 61.80 ± 5.49) were prospectively examined by the carotid ultrasound Doppler (carotid measurements included plaque thickness PT - nonstenotic plaques (carotid stenosis <50%) and stenotic culprit plaques (carotid stenosis ≥50%), mean CIMT and maximum CIMT). Subjects were followed for 36 months from the inclusion in the study (regular control examinations). Data were recorded on new cases of mortality (CV mortality) and adverse CV events (myocardial infarction - -MI, surgical or endovascular revascularization - coronary or stroke).

Results: In this study, CIMT values vary between 0.62 and 1.43 mm (mean CIMT = 1.21 ± 0.2 mm) while 52 subjects had nonstenotic plaques (14 respondents plaque ulceration, 22 type 2 diabetes mellitus, 38 arterial hypertension) and 38 subjects had stenotic culprit plaques (17 respondents plaque ulceration, 20 type 2 diabetes mellitus, 31 arterial hypertension). After 36 months of follow-up, 76 vascular events were noted (MI, transient ischaemic attack - TIA, stroke and cardiovascular angioplasty or surgery) in this period.

Conclusion: Respondents with carotid plaques had higher cardiovascular events occurrence (p < .01, high statistical difference). Carotid plaques as a parameter have higher predictive vascular event value importance than CIMT. Of note, stenotic plaques, the presence of ulceration on the free surface of the plaque, type 2 diabetes mellitus and hypertension were connected with the highest events occurrence.

Objectives: The aim of this study was to assess the mid-term outcomes of the use of drug-coated balloons (DCBs) to treat infrainguinal peripheral arterial disease (PAD) in patients with dyslipidemia.

Methods: BIOLUX P-III is a prospective, international, multicenter, all-comers registry-based study that was conducted at 44 sites with follow-ups at 6, 12 and 24 months. The present study is a subgroup analysis comparing the outcomes associated with endovascular revascularization with those associated with Passeo-18 lux DCBs in patients with and without dyslipidemia. The proportions of patients free from major adverse events (defined as device- or procedure-related mortality within 30 days, clinically driven target lesion revascularization (CD-TLR) and major target limb amputation), target vessel revascularization, and patient-reported outcomes within 24 months postintervention were compared between the two groups.

Results: A total of 876 patients with symptomatic PAD who underwent peripheral revascularization with DCBs and had information on their dyslipidemia status were included; 588 of those patients had dyslipidemia. There was no difference in the proportion of patients free from MAEs between the groups. The percentages of patients who were 6, 12 and 24 months free from CD-TLR were significantly lower in the dyslipidemia group than in the nondyslipidemia group (86.3% vs 91.9% at 2 years, p = .0183). Similarly, the percentage of patients free from target vessel revascularization was lower in the dyslipidemia group at all timepoints (83.3% vs 89.3% at 2 years, p = .0203). There was no difference in mortality or major or minor limb amputation rates. Other secondary outcomes were similar between the groups.

Conclusions: Compared to those without dyslipidemia, patients with symptomatic PAD and dyslipidemia who underwent revascularization with a Passeo-18 lux DCB had greater rates of CD-TLR and TVR. However, having dyslipidemia did not increase the risk of mortality or limb amputation.

Clinical trial registration: NCT02276313.