Vascular最新文献

BackgroundThe diagnosis of deep vein thrombosis (DVT) is usually made by a sonographer using a thorough Doppler ultrasound. The current study examined whether emergency resident physicians could accurately diagnose DVT using a point-of-care, three-point compression protocol.MethodsThe patient population consisted of patients with suspected DVT who presented to the emergency department between 2021 and 2022. All patients underwent a three-point compression ultrasound exam by the emergency resident. Each patient then had a comprehensive whole-leg ultrasonography exam performed by a supervisor emergency specialist. The results of the ultrasound exams by the emergency resident physicians and comprehensive exams were then analyzed and compared.ResultsThe average age of the patients was 60,96 ± 16,67. There was a statistically significant difference between three-point compression and whole-leg ultrasound examination data. The negative predictive value of the resident physician was determined as 94%. The coefficient of the compression variable in the Ridge regression analysis for diagnosing DVT in the whole-leg ultrasound examination was obtained as -0.3754.ConclusionsWe think that compression ultrasonography may be sufficient in patient management compared to whole-leg ultrasonography in emergency management. However, we think that three-point compression ultrasonography applied by the emergency resident is quite successful in diagnosing and excluding DVT in the emergency department.

Background and AimMalignant carotid body tumors (CBTs) represent a rare clinical entity, with existing studies limited by small sample sizes and fragmented data. This systematic review aims to: (1) Pool epidemiological estimates of malignant CBTs; (2) Characterize clinicopathological profiles; (3) Evaluate treatment modalities and survival outcomes; (4) Identify risk factors for malignant transformation.MethodsA comprehensive search of PubMed, Scopus, Cochrane Library, and Web of Science was conducted through January 1, 2024 for literatures with malignant CBTs. The incidence, clinicopathological features, management and survival of patients with malignant CBTs were pooled analyzed and described. Benign and malignant CBTs were compared to identify any relevant risk factors of malignant transformation for CBTs. Two independent reviewers performed study selection, data extraction, and quality assessment. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.ResultsA total of 99 reports and 447 patients with malignant CBTs were identified. The pooled results indicated that the incidence of malignant CBTs was 5% (4% ‒ 6%) with a mean age of 44.11 years. In addition, female patients with malignant CBTs accounted for 61% and 14.58% experienced bilateral lesions. 74.63% malignant CBTs were defined as Shamblin III with a mean maximal diameter of 5.19 cm. We found that compared to patients with benign CBTs, patients with malignant CBTs experienced significantly higher proportion of Shamblin III (OR 4.65; 95% CI 1.80-12.06) and preoperative symptoms (hoarseness/dysphonia) (OR 7.96; 95% CI 1.79-35.5) respectively. It was observed that patients with malignant CBTs experienced more vascular and neurologic complications including vascular reconstruction or repair (OR 19.22; 95% CI 6.23-59.3), overall neurological complication (OR 3.81; 95% CI 1.28-11.36) and permanent nerve deficits (OR 3.95; 95% CI 1.26-12.41) respectively.ConclusionsThis meta-analysis established that malignant CBTs were more likely to be Shamblin III with larger size and common in middle-aged female. The majority of patients with malignant CBTs experienced preoperative systems. Preoperative hoarseness/dysphonia was associated with malignancy. Malignant CBTs increased vascular and neurologic complications. Postoperative radiotherapy was mainly used for malignant CBTs. Cohort studies with enough sample size and long follow-up are required to clear the risk factors, treatment and survival of malignant CBTs.

PurposeTo describe the endovascular treatment of symptomatic pararenal abdominal aortic aneurysm (PAAA) with severe infrarenal angulation using a combination of Prolene Encircling Reducing Ties (PERT), through-and-through wire, and a physician-modified 4-fenestrated endograft (PMEG).TechniqueA 73-year-old male presented with symptomatic PAAA with a 105-degree infrarenal angulation. A right common femoral artery (CFA) to right axillary artery through-and-through wire (0.035 soft hydrophilic wire) was placed, and a modified Valiant Captivia stent graft was advanced through the right CFA. The modified stent graft was deployed until the superior mesenteric artery (SMA) fenestration was opened. The SMA fenestration was then adjusted to the correct position, then the free-flow bare stent was opened. Sequential deployment of the modified stent graft was performed. After successful cannulation of three visceral arteries (SMA and renal arteries) from axillary approach, a 7 Fr sheath was advanced into the SMA, and the modified stent graft was fully deployed. Following removal of the delivery system, the stent graft was fully opened by compliance balloon inflation, which ruptured the 6-0 Prolene ties. The SMA and both renal arteries were then stented and flared. A modified bifurcated Endurant stent graft (without free-flow bare stent) was deployed approximately 1 cm below the lowest renal fenestration, and the iliac limbs were deployed to complete the procedure. 6-month follow-up computed tomography angiography (CTA) demonstrated complete exclusion of the aneurysm without endoleak.ConclusionA combination of PERT, through-and-through wire, and PMEG for the treatment of symptomatic PAAA with severe infrarenal angulation demonstrated acceptable early results.

ObjectiveThe purpose of this study was to evaluate the impacts of obesity on patients undergoing aortobifemoral bypass for aortoiliac occlusive disease (AIOD). AIOD is an atherosclerotic disease of the suprainguinal arteries, and treatment approaches are often guided by the TASC II classification. The obesity paradox, a phenomenon where higher-than-normal BMI individuals exhibit better outcomes in various medical conditions, has yet to be fully understood in the context of AIOD.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried for AIOD cases between January 1, 2011 and December 31, 2016. All patients included in the AIOD targeted files were eligible for inclusion unless their BMI was missing. Patient demographics and surgical characteristics were analyzed across BMI, categorized as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), obese (30-34.9), and very obese (≥35). Multivariable logistic and linear regression models, adjusting for demographics, comorbidities, and AIOD symptoms, were used to estimate the association between BMI and patient outcomes.ResultsOverall, 4885 patients met inclusion criteria, of which 274 (6%) patients were underweight, 1720 (35%) were normal weight, 1649 (32%) were overweight, 843 (16%) were obese, and 399 (8%) were very obese. Among all groups, neither age nor symptoms were significantly different. The functional status of the patients across all groups was also similar. Compared to normal-weight patients, obese and very obese patients were significantly more likely to be diabetic (34% and 50% vs 16%) and have hypertension (82% and 84% vs 5%), p < .0001. Both obese (OR 2.11, 95% CI 1.47, 3.04) and very obese patients (OR 2.94, 95% CI 1.95, 4.45) had significantly higher incidences of infection. Very obese patients also had a higher incidence of pneumonia (OR 2.03, 95% CI 1.11, 3.74) and prolonged ventilator requirement (OR 3.09, 95% CI 1.86, 5.14) compared to normal-weight patients. No differences were seen in mortality (p = .92) or length of stay (p = .20).ConclusionAn elevated body mass index (BMI) is associated with a higher vulnerability to infection, pneumonia, and an extended need for ventilation after open aortobifemoral bypass surgery. However, there was no association between BMI and 30-day mortality or duration of hospitalization in patients who had AOBF bypass.

ObjectivesWhile concomitant vascular injury is associated with an increased risk of amputation following lower extremity trauma, risk factors for amputation after attempted revascularization are lesser known. In centers where dedicated vascular traumatic expertise is not available, a lack of guidance regarding high-risk vascular trauma may limit efforts to appropriately triage and transfer patients to a higher level of care. We identified factors associated with in-hospital amputation after revascularization for isolated lower extremity trauma.MethodsThe American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) is a multicenter, prospectively maintained database containing deidentified traumatic admissions data for over 900 trauma centers in the United States. From 2017 to 2021, ACS TQIP was queried for adult patients undergoing arterial revascularization following isolated lower extremity trauma. Injury-related variables were derived from structured data fields, Injury Severity Scores, and Abbreviated Injury Scores. The primary endpoint was post-revascularization in-hospital lower extremity amputation. Univariate and multivariate logistic regression of demographic data, medical history, and injury-related variables were performed to identify factors associated with post-revascularization amputation.ResultsOf 5669 patients undergoing revascularization, 10.2% underwent amputation a median 8.31 days after their surgical procedure. Most revascularizations were done via open surgical approach (81.9%), followed by endovascular (13.8%) and hybrid (4.3%) methods. Amputated patients were older (39.5 vs 35.6 years, p < 0.001, Table 1) and more likely to have a preoperative history of peripheral arterial disease (1.4% vs 0.6%, p = 0.017). On multivariate logistic regression, blunt mechanism (OR 4.80, p < 0.001, Table 2), popliteal arterial injury (OR 2.11, p < 0.001), and concurrent bony injury (OR 2.03, p < 0.001) were independently associated with amputation.ConclusionsIn the multicenter American College of Surgeons Trauma Quality Improvement Program, the overall rate of post-revascularization amputation in patients with isolated lower extremity trauma was 10.20%. Amputation risk was higher in patients with advanced age and comorbidity, suggesting that triage for revascularization already incorporates an evaluation of patient frailty. In multivariate analysis, blunt mechanism of injury, popliteal artery injury, and bony injury were independently associated with amputation. Each additional hour between admission and revascularization was associated with greater amputation risk, highlighting the importance of efforts to expediently and appropriately triage patients at with high-risk injuries to optimize limb salvage outcomes.

BackgroundVenous malformations (VMs) are the most common type of vascular malformation. Recurrence after treatment remains a significant challenge in clinical management.MethodsA multi-center retrospective cohort study was conducted on consecutive patients who received surgical or endovascular VM treatment from 2005 to 2020. The study aimed to compare treatment efficacy between surgical and non-surgical endovascular approaches. Post-treatment size, symptoms, and recurrence were evaluated more than 1 year after treatment.ResultsNinety-eight patients with 288 VM treatment cases were included. The mean follow-up duration was 60.7 ± 42.4 months. Both surgical and non-surgical treatments showed size improvement and symptom improvement in more than 90% and 75% of the cohort, respectively. Regarding recurrence, patients who underwent total resection (26.5%; p < .001) and primary closure (44.6%; p = .04) had significantly lower recurrence rates among the whole cohort.ConclusionWhere feasible, total resection is the ideal treatment modality. Sclerotherapy has a higher long-term recurrence rate but is a less invasive procedure that can be performed repeatedly.

BackgroundThe global adoption of endovascular aortic techniques has progressed rapidly, yet the extent of Latin America's participation in this revolution requires comprehensive evaluation. This review examines the region's current capabilities, innovations, and barriers in aortic endovascular therapy.MethodsWe conducted a systematic analysis of published experiences and institutional reports from across Latin America, focusing on three key areas: ascending/arch aortic interventions, thoracoabdominal repairs, and endoleak management strategies.ResultsThe region has demonstrated significant progress in adopting complex endovascular therapies despite resource limitations. Several centers have successfully implemented advanced techniques, including total percutaneous arch repairs, hybrid debranching procedures, and customized endograft solutions. Experience with thoracoabdominal pathologies shows promising outcomes with fenestrated and branched endografts, while innovative approaches to endoleak management have been developed, particularly for challenging type II and III cases. However, variability in outcomes persists due to disparities in technology access, training opportunities, and follow-up protocols. The available evidence, while growing, remains largely limited to single-center experiences with modest sample sizes.ConclusionLatin America has made measurable strides in aortic endovascular therapy, demonstrating both technical capability and innovative adaptations to local challenges. The establishment of a Latin American Aortic Registry (LATAR) would address critical gaps in data standardization, facilitate outcome benchmarking, and promote equitable technology dissemination. Such structured collaboration is essential for the region to fully participate in the global advancement of aortic care.

ObjectiveTo report on the surgical treatment of complex renal artery aneurysms (RAAs) using kidney autotransplantation in two patients at a single institution.MethodsWe retrospectively reviewed two cases of patients with RAA treated with renal autotransplantation at a single center over a period of 15 years.ResultsCase 1: A 50-year-old male presented to the outpatient clinic with left flank and lumbar pain. A CT scan revealed a 25 mm aneurysm at the left renal pelvis and bilateral renal fibromuscular dysplasia. A laparoscopic left nephrectomy was performed, followed by bench aneurysm resection, saphenous vein bypass reconstruction, and kidney autotransplantation into the right iliac fossa. At 11 years follow-up, his renal function remains normal, with adequate patency and function of the transplanted kidney. Case 2: A 51-year-old male reported a 6-month history of nonspecific abdominal pain. A CT scan revealed nephrolithiasis and multiple renal artery aneurysms, the largest measuring 50.2 mm in his right kidney. He underwent laparoscopic right nephrectomy and renal autotransplantation in the right iliac fossa. At 3 years follow-up, the patient remains asymptomatic with normal renal function.ConclusionEx vivo autotransplantation is an acceptable option for addressing complex RAAs beyond the bifurcation of the main renal artery.

IntroductionThe great saphenous vein (GSV) is the preferred conduit for infrainguinal arterial bypass procedures, due to its long-term patency and resistance to infection. However, traditional harvesting methods, including open vein harvesting (OVH) with continuous or skip incisions, pose significant risks of wound complications, with reported rates as high as 40%. To address these issues, minimally invasive techniques such as endoscopic vein harvesting (EVH) have emerged, promising reduced complications while maintaining graft integrity. This comprehensive review synthesises the current literature on various saphenous harvesting techniques, evaluating their impact on graft patency and postoperative complications.MethodsA systematic electronic literature search was conducted using PubMed and Embase, focussing on articles published between 2013 and 2023. The search utilised keywords related to infrainguinal bypass, saphenous vein harvesting, and associated complications. Nine relevant studies were selected for analysis, assessing outcomes related to different harvesting techniques.ReviewThe reviewed studies present mixed results regarding wound complications and graft patency. Wartman et al. found comparable 30-day wound complication rates between EVH and OVH (29% vs 27%), with no significant differences in long-term patency rates. In contrast, Eid et al. reported significantly higher wound infections in the OVH group (20.4% vs 0% in EVH), but OVH demonstrated superior primary patency at 30 months (69.4% vs 43.2% for EVH). Santo et al. supported this, noting better primary patency rates for OVH (71% at one year) compared to EVH (58%). Teixeira et al. found no significant differences in surgical site infections across techniques but highlighted inferior one-year primary patency rates for EVH. Additionally, Mirza et al. corroborated OVH's superior primary patency (62.8% vs 47%). Conversely, Kronick et al. indicated lower wound complications in the EVH group (2% vs 28% for OVH). The systematic review by Jauhari et al. revealed a pooled hazard ratio indicating inferior patency for EVH.Discussion/ConclusionsThe findings indicate that while EVH offers advantages in terms of reduced wound complications, concerns regarding long-term graft patency persist. The data suggest that OVH may provide better primary patency, although both techniques have their unique benefits and drawbacks. Surgical choice should consider patient-specific factors such as comorbidities and anatomical variations. A thorough understanding of these harvesting techniques is essential for improving patient outcomes in infrainguinal bypass surgery. Future research is needed to identify optimal harvesting strategies and enhance the efficacy of vein harvesting techniques, balancing complication rates with graft performance to inform clinical practice.

ObjectivesProsthetic infection is a feared complication following vascular surgery and is associated with significant morbidity. Recently, biologic wound care adjuncts have been used more given their advantageous effects on wound healing. The goal of this study is to evaluate the outcomes of patients who underwent placement of biologic wound care products over prosthetics with the goal of observing reduced deep dehiscence involving the prosthetic or prosthetic infections.ResultsFrom June 1, 2023 to June 26, 2024, 13 patients met criteria for inclusion. Ten of the 13 (77%) involved placement of a prosthetic in a revision field as the primary indication; two of the 13 (15%) involved high-risk prosthetics in either obese fields or in fields with little soft tissue coverage over a prosthetic implant (1/13, 8%). Overall, there was one graft infection (8%) and there were no deep dehiscence occurrences which involved the underlying prosthetic. The graft infection occurred after a failed surgical thrombectomy, which involved a surgical cutdown at a new surgical site over a femoral-tibial prosthetic bypass in a patient had previously demonstrated a fully healed wound with no indication of wound infection. No other patients suffered a deep dehiscence of their wound involving the prosthetic or graft infection.ConclusionThis study demonstrates the feasibility of prophylactic use of biologic products with the hope of preventing deep space infection involving underlying prosthetics. More studies are needed to evaluate this technique; however, these early results are promising.