Vascular最新文献

ObjectivesNon-pneumatic compression devices (NPCDs) rely on shape-memory alloy technology that allows patients to ambulate and remain active during lymphedema treatment. This study examines the effect of the NPCD on foot and ankle swelling.MethodsThis was a prospective, non-randomized study of patients with phlebolymphedema (venous insufficiency-related lymphedema) treated with a novel NPCD for 4 weeks. Ankle and foot circumference (cm), and volume measurements (ml water displacement using immersion) of the foot and ankle were obtained at enrollment, 2-weeks, and 4-weeks, and ambulation was tracked with a wearable exercise monitoring device.ResultsThis study included 13 patients (21 limbs). A significant reduction in circumference (ankle (-0.84 ± 0.22 cm, p < .01) and metatarsal bed (-0.55 ± 0.95, p < .01)) and volume (foot/ankle (-52 ± 22 mL, p = .032)) was observed. Patients reported a mean of 8100 steps per day (±6100).ConclusionsNPCD results in significant reduction in edema in the foot and ankle despite garments lacking a foot piece. Patients remained mobile while adhering to therapy.

PurposeTo report the 10-year follow-up of a patient managed with a custom-made fenestrated endograft, including a large fenestration for the preservation of a celiac trunk (CT) anatomic variation.Case reportIn 2014, a 75-year-old female was treated endovascularly for descending thoracic and visceral aortic pseudoaneurysms (PA). Due to a celiac trunk (CT) anatomic variation, consisting of separate origins of the hepatic and splenic artery, a custom-made four-fenestrated endograft was planned, including a large fenestration (18 × 10 mm) for CT preservation. Balloon-expandable covered stents bridged all target vessels (TVs), except the large fenestration, which was left unstented. Imaging at 10 years showed patency of TVs, no signs of instability or device migration and complete PA exclusion.ConclusionUsing a patient-specific device for complex endovascular aortic repair provided favorable extended follow-up outcomes. An unstented large fenestration remained patent during 10 years of follow-up. This case highlights the importance of individualized approach in complex aortic pathologies.

ObjectivesWe aim to evaluate the safety and effectiveness of the Zenith Dissection Endovascular System (ZDES; Zenith TX2 Dissection Endovascular Graft with Pro-Form and Zenith Dissection Endovascular Stent), which uses a proximal stent graft along with a distal bare metal stent compared to traditional stent grafts in the repair of acute, complicated Type B Aortic Dissection (AcTBAD).MethodsThis retrospective study reviews the medical charts of 32 patients with AcTBAD repaired at a single urban academic medical center. 16 of these AcTBAD cases were repaired with the ZDES (87.5% male; mean age, 63.1 years), and 16 were repaired with stent grafts (62.5% male; mean age, 60.6 years). Outcomes include 30-day morbidity, false lumen thrombosis and aneurysmal degeneration at 6 months and 1 year, thirty-day and three-year mortality, and freedom from secondary surgical intervention.ResultsTwelve total postoperative adverse events occurred in the ZDES group compared to 37 in the stent graft group (p = .046). The notable adverse events included renal insufficiency (p = .04) and refractory pain (p = .002). At the 6-month follow-up, complete or partial false lumen thrombosis was noted in 100% of patients (16/16) in the ZDES group and 56.3% of patients (9/16) in the stent graft group (p < .01). At the 12-month follow-up, complete or partial thrombosis of the false lumen was noted in 1 additional patient in the stent graft group for a total of 62.6% of patients (10/16; p = .018). Growth (>5 mm) of the maximum transaortic diameter at 12 months was noted in 33.3% of patients (5/15) in the ZDES group and 54% of patients (7/13) in the stent graft group (p = .45). Thirty-day mortality occurred in one patient in the ZDES group and no patients in the stent graft group (p = 1.0). Three-year mortality occurred in four patients in the stent graft group and no patients in the ZDES group (p = .11). Although more patients in the ZDES group underwent secondary intervention to address aortic growth, there were no differences between the two groups in freedom from any secondary intervention at 365 days post-procedure (p = .13).ConclusionsPatients treated with ZDES had fewer post-procedural adverse events. Although the use of the ZDES had favorable false lumen thrombosis at 6 and 12 months, the device was not associated with a statistically significant change in transaortic diameter. Our single institution study demonstrated that ZDES has favorable clinical outcomes, but further investigation is needed to better understand aortic remodeling in the distally stented regions. Additionally, further research is necessary to explore the incidence of endoleaks associated with ZDES to optimize long-term patient outcomes.

ObjectivesAnemia is known to be prevalent in patients with diabetic foot ulcers, but such was not documented in those who required lower extremity amputations (LEAs). In this high-risk population, preoperative anemia could be an additional risk factor for postoperative morbidity and mortality. This study attempts to address the knowledge gap related to the preoperative hemoglobin (Hg) level and anemia prevalence in patients admitted for diabetic LEA.MethodsUsing a cross-sectional design, the primary outcomes were defined as the mean preoperative Hg level and anemia frequency. Mean differences and sex-based results were calculated and compared between three categories: major, midfoot, and forefoot amputation groups. Correlation between Hg level and serum creatinine was set as a secondary outcome.ResultsA total of 141 patients comprising 192 amputation cases were included. The mean Hg value for the whole sample was 10.6 ± 1.8 g/dl. Only 18 patients (9.7%) had a normal Hg level and 174 (90.3%) were anemic: 90 cases (46.8%) with mild anemia, 76 (40.8%) with moderate anemia, and 8 cases (4.3%) with severe anemia. No significance was found between mean Hg values of the three groups or between sex groups. A significant negative correlation between the levels of serum creatinine and Hg was found (p = .037).ConclusionsAn overwhelming majority of patients admitted for diabetic LEA were anemic. Since anemia could impede limb perfusion and induce higher postoperative mortality rate, adjusting this confounder could be justified. Future research should aim to evaluate the impact of preoperative blood component transfusion on postoperative complications following diabetic LEA.

IntroductionPeripheral artery disease (PAD) poses a growing clinical challenge due to an aging population, despite advances in treatment methods. Various scoring systems have emerged to predict high-risk patients, including the HALP (hemoglobin, albumin, lymphocyte, and platelet) score, known for predicting prognosis in cancers and stroke. This study assesses the HALP score's relation to lesion severity and long-term mortality in PAD patients.MethodsWe retrospectively analyzed 305 symptomatic PAD patients undergoing endovascular intervention. The following formula was used to calculate the HALP score: hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L) / platelet count (/L). Lesion severity was classified by TASC-II: TASC AB and TASC CD. Mortality data were obtained from hospital and social security records.ResultsThe study involved 305 patients (mean age 64.4 ± 11.8 years; 72.1% male), divided into survivors (208) and non-survivors (97). ROC analysis identified HALP score as the strongest predictor of long-term mortality (AUC: 0.736; 95% CI: 0.679-0.793; p < .001). HALP score (HR, 0.087; 95% CI, 0.025-1.300; p < .001), age (p < .001), DM (p = .007), and CRP (p = .013) independently predicted mortality. Kaplan-Meier analysis showed higher HALP scores linked to lower long-term mortality (Log-rank: 20.102, p < .001), with an average follow-up of 48 ± 18 months.ConclusionThe HALP score emerged as a robust predictor of PAD prognosis, surpassing individual components and other parameters. Lower HALP scores correlated with more severe lesions and reduced life expectancy.

ObjectivesThis study aimed to investigate the feasibility of a commercially available tomographic freehand three-dimensional ultrasound (3D-US) system for surveillance of abdominal aortic aneurysms (AAAs) after endovascular repair (EVAR).MethodsIn 10 patients who underwent EVAR, a 3D-US scan was obtained post-operatively in addition to regular computed tomography angiography (CTA). Five independent observers evaluated 12 EVAR surveillance parameters for the 10 scans, resulting in a total of 600 individual observations.ResultsThe diameters of the neck, sac and iliac arteries were evaluable in most of the observations (neck: 80%, AAA sac: 98%, right CIA: 90%, left CIA: 68%). The diameter measurements of the 3D-US strongly correlated with the diameters measured on CTA (ρ = 0.90, p < .001). The general offset of 3D-US compared to CTA was -4.4 mm and the proportional bias was 3%. For all observers, the diameter measurements were significantly strongly correlated (O1:ρ = 0.85, O2:ρ = 0.88, O3:ρ = 0.93, O4:ρ = 0.96, O5:ρ = 0.86, p < .001 for all). The inter-observer reliability was excellent with an overall concordance correlation coefficient of 0.98. The start of the endograft, the lowest renal artery, the distance between these landmarks, and the proximal and distal sealing zones were evaluable in fewer than half of the observations (42%, 12%, 10%, 32%, 32%, 26%).Conclusion3D-US after EVAR is feasible. Diameters measured in 3D-US correlate strongly with CTA-based diameters and have a good interrater variability. However, the sealing zones are difficult to assess on 3D-US. This technique could be a useful addition to duplex ultrasound to facilitate offline 3D analysis, increase measurement reproducibility, enable volume measurements, and minimise the use of harmful CTA for surveillance after EVAR.

ObjectivePeripheral artery disease (PAD) is a chronic circulatory disorder characterized by atherosclerotic plaque buildup in the peripheral vascular system, restricting blood flow to the lower extremities and carrying a significant risk of morbidity and mortality. This study investigates the role of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic marker for assessing the severity of lower extremity peripheral artery disease (LEAD). The HALP score integrates hematologic and nutritional markers, providing a composite index that may reflect both the inflammatory and nutritional states impacting LEAD progression.MethodsA cross-sectional retrospective study was conducted, analyzing 186 patients diagnosed with LEAD through peripheral angiography. Participants were classified according to the TransAtlantic Inter-Society Consensus (TASC) II criteria, with mild to moderate disease (TASC A-B) and severe disease (TASC C-D). Laboratory data were collected within the first week of diagnosis, and HALP scores were calculated. The association between HALP scores and LEAD severity was evaluated through correlation and logistic regression analyses. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were also analyzed.ResultsSignificant differences were observed between TASC A-B and TASC C-D groups in demographic and clinical variables. Patients in the severe LEAD group were older, had a higher prevalence of diabetes and hyperlipidemia, and exhibited lower hemoglobin and albumin levels with higher platelet counts (p < .001). A significant inverse correlation was found between HALP score and LEAD severity (R = -0.607, p < .001), indicating that lower HALP scores are associated with more advanced disease. The HALP score displayed strong discriminatory performance in ROC analysis (AUC = 0.889), with an optimal cut-off of 3.14 providing 81% sensitivity and 80% specificity for predicting severe LEAD.ConclusionThe HALP score is a valuable, non-invasive predictor of LEAD severity and may serve as a practical tool for clinical risk assessment. Incorporating the HALP score into routine evaluation protocols could support more personalized management approaches for patients with LEAD, guiding both therapeutic decisions and long-term monitoring.

ObjectivesTo evaluate the efficacy of different methods of interfacial elastic compression and their association with obesity and chronic venous insufficiency (CVI).MethodsForty legs with vascular disease and 40 control legs were analyzed. Four different methods of elastic compression were applied and interface pressure was measured. Blood flow volume and peak systolic velocity (SPV) were measured before and during compression.ResultsAlthough there are no general differences correlating higher interface pressures with higher blood flow volume and SPV in CVI patients and controls, there are specific differences related to obesity. Obese participants had lower CVI and higher blood flow volume, in whom higher interface pressure promoted better results.ConclusionsThere is no standard method of compression for all patients. Variables such as the presence of CVI, body mass index, and gender must be taken into account in order to achieve a better individual method of compression therapy.

BackgroundEndovascular therapy with balloon percutaneous angioplasty (PTA) in the femoro-popliteal segment is frequently performed, however, long-term favorable outcomes and patency remain challenging, with restenosis rates reaching 60% post-standard balloon angioplasty. Drug-coated balloons (DCBs) have shown promise in improving these outcomes; Paclitaxel, used in DCBs, inhibits hyperplasia and smooth muscle cell proliferation, reducing restenosis; however, the optimal dose of Paclitaxel remains unclear, with high-dose (HD-DCB [>3 mg/mm²]) and low-dose (LD-DCB [<2.0 mg/mm²]) options available. This meta-analysis aims to compare the efficacy and safety of HD-DCB and LD-DCB in treating femoropopliteal arterial disease.MethodsWe followed PRISMA guidelines and conducted a comprehensive search of PubMed, EMBASE, Cochrane, Scopus, and Mendeley up to May 27, 2024. We included randomized controlled trials and cohort studies comparing HD-DCB and LD-DCB in patients with femoropopliteal arterial disease. Data were extracted on baseline characteristics, outcomes, and study quality. The Newcastle-Ottawa Scale and ROB2 tool were used for bias assessment. Outcomes included overall survival (OS), limb salvage (LS), freedom from clinically driven target lesion revascularization (CD-TLR), and major amputation.ResultsSix studies comprising 2563 patients were included. HD-DCB showed a significant benefit in limb salvage at 6 months (RR = 0.38, 95% CI = 0.18-0.78, p = .009) but not at 12 months (RR = 3.08, 95% CI = 0.14-67.13, p = .47). No significant difference was observed in overall survival between HD-DCB and LD-DCB at either 6 months (RR = 1.53, 95% CI = 0.25-9.57, p = .65) or 12 months (RR = 1.21, 95% CI = 0.17-8.84, p = .85). HD-DCB was associated with an increased risk of perioperative complications (RR = 1.90, 95% CI = 1.14-3.17, p = .01) and a higher, though not statistically significant, risk of major amputation (RR = 4.73, 95% CI = 0.54-41.52, p = .16).ConclusionHD-DCB may offer advantages in limb salvage over LD-DCB in the short term, but this comes with an increased risk of perioperative complications. These findings underscore the need for careful patient selection when considering HD-DCB for femoropopliteal artery disease.