Vascular最新文献

Objectives: Treatment of thoracoabdominal aortic aneurysms in high surgical risk patients can be challenging. Reports of physician-modified inner-branched endovascular repair (PMiBEVAR) are increasing. Despite low morbidity and mortality rates, re-interventions for endoleaks with these grafts are serious. There are no reports of additional treatment for PMiBEVAR failure.

Methods/results: A 75-year-old man presented to our hospital with a Crawford's type IV thoracoabdominal aortic aneurysm. A PMiBEVAR was performed. Postoperative computed tomographic angiography revealed an endoleak from the inner branch of the right renal artery. A re-intervention was performed with coil embolization of the endoleak. Imaging after re-intervention showed successful obliteration of the endoleak.

Conclusions: We thereby report a successful case of re-intervention for PMiBEVAR failure.

Objective: It is often difficult to alleviate foot pain associated with critical limb ischemia (CLI) using common analgesics. Neuraxial block is contraindicated in anticoagulant therapy. This study was designed to determine the response to subcutaneous injection of lidocaine around the network of peripheral nerves around the ankle in patients with CLI pain on anticoagulants and antiplatelets.

Methods: Sixteen patients with CLI pain in the foot were enrolled in this double-blind placebo-controlled crossover study. Patients were randomized to receive either 2% lidocaine or saline via catheters inserted into the subcutaneous area around the ankle. After recurrence of pain, the patients were crossed over to receive the alternative treatment. Pain was assessed with a numerical rating scale (NRS) before and 15 min after injection. Patients used a descriptive scale to grade pain control and were asked to determine the duration of analgesia in each arm of the study.

Results: No serious complications including protracted bleeding occurred. Lidocaine significantly decreased the NRS on movement from 10 (6, 10) [median (range)] to 2 (0, 10) (p < .001), and the differences in the Δ change in NRS between lidocaine and placebo were significant (p = .009). Of the 16 patients, 14 patients were very satisfied after lidocaine but only one described the same after saline. The effect of lidocaine and placebo lasted 11 (0, 28) and 1 (0, 22) h, respectively.

Conclusion: Subcutaneous injection of lidocaine around the ischemic ankle affectively alleviated pain in patients with CLI without serious adverse effects under anticoagulant therapy.

Purpose: Here we present a case of a 62-year-old female with a delayed ulnar artery pseudoaneurysm presentation after cardiac catheterization.

Case report: A 62-year-old woman with multiple medical comorbidities including end-stage renal disease (ESRD) on hemodialysis (HD) and atrial fibrillation on tablet apixaban who presented 8 weeks after cardiac catheterization through right ulnar artery access with a pulsatile mass, pain, and tingling of her right-hand fingers. Ultrasound exam confirmed presence of ulnar artery pseudoaneurysm with >2 cm active chamber. This pseudoaneurysm was repaired via forearm exploration, evacuation of hematoma, and primary repair with non-absorbable sutures.

Conclusion: We report a case of delayed ulnar artery pseudoaneurysm presentation following cardiac catheterization through the right ulnar artery. Open surgical repair offers a definitive addressal of ulnar artery pseudoaneurysm and removes ulnar nerve compressive neuropathy with less risk of distal embolization in patients with delayed pseudoaneurysm presentation whenever ultrasound-guided thrombin injection (UGTI) is contraindicated.

Objectives: Previous research had shown that age, a positive family history, comorbidities, major surgical operations, gestation, and use of several medications could increase the incidence of venous thromboembolism (VTE). With the development of medical and clinical individualized treatment, many people exposed to above risk factors did not develop VTE, suggested that genetic factors are also involved in the development of VTE. In this review, we aim to summarize VTE diagnosis and treatment in pregnancy women related to gene polymorphism.

Methods: A comprehensive electronic search using PubMed, MEDLINE, EMBASE and Web of Science was conducted to find relevant journal articles with key search terms including: "pregnancy OR pregnant," "venous thromboembolism OR VTE," "deep vein thrombosis OR DVT," "pulmonary embolism OR PE," and "genetic OR gene." Prominent publications from establishment of database till present were analysed to achieve a deeper understanding of VTE during pregnancy relate to genetic polymorphism, and the information was then collated to form this review.

Results: The literature review revealed that inherited thrombophilia significantly associated with the development of VTE, especially the factor V Leiden (FVL) and prothrombin gene mutation (PGM). Furthermore, the role of methylenetetrahydrofolate reductase (MTHFR) gene mutation in the development of pregnancy-related VTE remains controversial, further study is required. In the present study, Marburg I polymorphism (G511 E), c.1538 G>A and c.1601 G>A in Factor V (FV), JAK2V617 F mutation were reported as an independent risk factor for VTE, there is no sufficient evidence to confirm the gene mutation is related to VTE during pregnancy, these factors appearing as another promising potential diagnostic marker of VTE during pregnancy. Besides, the dosages of heparin in the treatment of VTE during pregnancy need be adjusted according to gene polymorphism of these population, particularly FVL or PGM carriers, and this area is not studied deeply, it is worth further study.

Conclusion: Inherited thrombophilia significantly associated with the development of VTE, especially the FVL and PGM, however the relation between MTHFR gene mutation and pregnancy-related VTE remains controversial, further study is needed. In addition, the dosages of heparin in the treatment of VTE during pregnancy suggested to adjusted based on gene polymorphism in FVL and PGM, and establish better prediction models is a direction of future research.

Background: The retrieval of inferior vena cava filters beyond the retrieval window poses challenges, requiring alternative techniques.

Objectives: To discuss the laparoscopy-assisted retrieval approach for difficult inferior vena cava filters.

Research design: Case report.

Subjects: A 57-year-old male with a retrievable inferior vena cava filter placed 8 months prior.

Measures: Laparoscopy-assisted retrieval technique utilized after unsuccessful interventional attempts.

Results: Successful retrieval of the filter despite thickened intimal tissue involvement, with no postoperative complications.

Conclusions: Laparoscopy-assisted retrieval offers a direct visual approach for challenging filter removal, proving minimally invasive, safe, and effective.

Objective: This study aims to provide effective treatment by comparing the venous recanalization responses of oral anticoagulants in deep vein thrombosis therapy.

Methods: From January 2013 to March 2019, a retrospective analysis was conducted on 109 patients who had been diagnosed with deep vein thrombosis and received treatment with apixaban, rivaroxaban, or warfarin within 1 week of symptom onset. Demographic, clinical data, and venous recanalization responses on Doppler ultrasonography of the patients that were followed-up 1 year from the date of diagnosis were evaluated.

Results: At the end of the 1-year follow-up, 21 (19.3%) patients had delayed recanalization, 39 (35.8%) patients had partial recanalization, and 49 (44.9%) patients had complete recanalization. The mean time to complete recanalization was 9.178 months for apixaban, 8.986 months for rivaroxaban, and 10.641 months for warfarin. Rivaroxaban was found to result in earlier completion of recanalization compared to warfarin (p = .012).

Conclusion: Direct oral anticoagulants might be more effective than vitamin K antagonists in achieving complete recanalization in patients that have deep vein thrombosis. Improving outcomes can be achieved by evaluating current treatment options.

Aim: The aim of this study was to investigate the potential of novel automated machine learning (AutoML) in vascular medicine by developing a discriminative artificial intelligence (AI) model for the classification of anatomical patterns of peripheral artery disease (PAD).

Material and methods: Random open-source angiograms of lower limbs were collected using a web-indexed search. An experienced researcher in vascular medicine labelled the angiograms according to the most applicable grade of femoropopliteal disease in the Global Limb Anatomic Staging System (GLASS). An AutoML model was trained using the Vertex AI (Google Cloud) platform to classify the angiograms according to the GLASS grade with a multi-label algorithm. Following deployment, we conducted a test using 25 random angiograms (five from each GLASS grade). Model tuning through incremental training by introducing new angiograms was executed to the limit of the allocated quota following the initial evaluation to determine its effect on the software's performance.

Results: We collected 323 angiograms to create the AutoML model. Among these, 80 angiograms were labelled as grade 0 of femoropopliteal disease in GLASS, 114 as grade 1, 34 as grade 2, 25 as grade 3 and 70 as grade 4. After 4.5 h of training, the AI model was deployed. The AI self-assessed average precision was 0.77 (0 is minimal and 1 is maximal). During the testing phase, the AI model successfully determined the GLASS grade in 100% of the cases. The agreement with the researcher was almost perfect with the number of observed agreements being 22 (88%), Kappa = 0.85 (95% CI 0.69-1.0). The best results were achieved in predicting GLASS grade 0 and grade 4 (initial precision: 0.76 and 0.84). However, the AI model exhibited poorer results in classifying GLASS grade 3 (initial precision: 0.2) compared to other grades. Disagreements between the AI and the researcher were associated with the low resolution of the test images. Incremental training expanded the initial dataset by 23% to a total of 417 images, which improved the model's average precision by 11% to 0.86.

Conclusion: After a brief training period with a limited dataset, AutoML has demonstrated its potential in identifying and classifying the anatomical patterns of PAD, operating unhindered by the factors that can affect human analysts, such as fatigue or lack of experience. This technology bears the potential to revolutionize outcome prediction and standardize evidence-based revascularization strategies for patients with PAD, leveraging its adaptability and ability to continuously improve with additional data. The pursuit of further research in AutoML within the field of vascular medicine is both promising and warranted. However, it necessitates additional financial support to realize its full potential.

Objectives: The study compared the outcomes between covered-stents grafting (CSG) and ligation of femoral artery (LFA) in the treatment of infected femoral pseudoaneurysm (IFP) caused by intravenous drug injection.

Methods: From 1^st January 2016 to 30^th November 2021, the clinical data of patients with IFP caused by intravenous drug injection who underwent CSG (n = 31, 55.4%) and LFA (n = 25, 45.4%) are retrospectively analyzed. We compared the baseline characteristics and clinical outcomes of the two groups, including early and late mortality and morbidity.

Results: A total of 56 patients were enrolled in the study, comprising 50 (89.3%) men and 6 (10.7%) women, with a mean age of 34.3 years. There was no significant difference observed between the two groups in terms of 30-day mortality (3.2% vs 0%, p = .365) and length of stay (9 [7, 12] vs 11 [8.5, 12.5] days, p = .236). However, group CSG exhibited a lower rate of intermittent claudication (0% vs 32%, p = .001), less blood loss (67.1 ± 22.5 mL vs 177.0 ± 59.8 mL, p < .001), and shorter surgery duration (57.5 ± 9.9 min vs 84.4 ± 22.8 min, p < .001) compared to group LFA. The LFA group were divided into subgroups according to the ligation site. The amputation rate of superficial femoral artery ligation group (0 vs 27.3%, p = .014) was significantly lower than common femoral artery ligation.

Conclusions: Covered-stents grafting may be a preferable treatment to LFA for IFP due to intravenous drug abuse, particularly when the entry tear is located in the common femoral artery.

Background: The aim of this study was to determine the incidence, clinical and paraclinical characteristics and outcomes of Covid-19 positive patients presenting in the Emergency Department (ED) with and treated for acute limb ischaemia (ALI) during a 2-year period.

Methods: This retrospective study was conducted in the ED of St. Spiridon County Clinical Emergency Hospital in Iasi, north-east region of Romania. The patients included in this study presented in the ED between March 1^st, 2020 and February 28^th, 2022 with ALI and Covid-19.

Results: During the study period, a total number of 141018 patients were evaluated in our ED, 8578 (representing 6,08%) patients being diagnosed with Covid-19. Of them, 98 (1.14% of all with Covid-19) presented ALI. The mean age was 70.9 ± 10.23 and 67.3% of the patients were males. At admission, 57% of patients had Covid-19-related pneumonia, identified on X-ray or CT scan. Of all patients, 81 (82%) were diagnosed with ALI in lower limbs with 10% of them having affected both limbs. 95% of the patients presented comorbidities, the main being cardiac (85%), diabetes mellitus (37%), vascular (24%) and neurological (22.6%). Non-survivor patients were more likely to have Covid-19 pneumonia on chest X-ray or CT scan, 92% versus 44% (OR 15, CI 3.3; 68, p < .01), lymphopenia 96% versus 70% (OR 10.2, CI 1.30; 80.9, p < .01), a NLR over 9.77% versus 30% (OR 7.5, CI 2.6; 21.4, p < .01), acidosis 65% versus 33% (OR 3.8, CI 1.4; 9.7, p < .01), abnormal AST, 69% versus 29% (OR 5.4, CI 2; 14.5, p < .01) and secondary amputation, 38.5 versus 11.1% (OR 5, CI 1.7; 14.7, p < 0.1). Overall, the mortality rate was 26.5%.

Conclusion: The prevalence of ALI in patients infected with Covid-19 who were evaluated in our ED was 1.14%. The highest mortality rate was probably related to Covid-19 pneumonia. We observed that patients with Covid-19 pneumonia, lymphopenia, a NLR >9, metabolic acidosis, increased AST at ED admission and secondary amputation had a higher mortality.

Objective: The main objective of this present paper was to evaluate the results and outcomes of patients with acute limb ischemia (ALI) submitted to pharmacomechanical thrombectomy (PMT) endovascular surgery with Angiojet, regarding the number of cycles/pumps.

Methods: Prospective, consecutive cohort study of ALI patients submitted to PMT endovascular intervention subdivided into two groups according to the number of cycles in the Angiojet technique: Group 1 higher than 150 cycles/second and Group 2 lesser than 150 cycles/second (cycles/s).

Results: Overall, 92 patients with ALI submitted to PMT were evaluated. Two groups of patients were identified: Group 1 higher than 150 cycles/s with 60 patients and Group 2 lesser than 150 cycles/s with 32 patients. The overall mortality rate (OMR) was 15.1% (13 patients) in total cohort within the first 30 days. Group 1 had a higher OMR than Group 2 (16.1% vs 9.3%, p = 0.007). There were 4 cases of hematuria (4.3%), all of them in Group 1. We have performed a Kaplan-Meier regarding limb salvage rates: Group 1 had 85% and Group 2 had 95.7% at 1057 days. P = 0.081. Among the factors evaluated, the following were related to overall mortality rate: PMT with higher >150 cycles/s (HR = 7.17, p = 0.007, CI: 1.38-8.89), COVID-19 infection (HR = 2.75, p = 0.010, CI = 1.73-5.97), and post-operative acute kidney injury (HR = 2.97, p < 0.001, CI = 1.32-8.13). Among the factors evaluated, the following was related to limb loss: post-operative acute kidney injury (HR = 4.41, p = 0.036, CI: 1.771-7.132), probably because patients experiencing limb loss have a higher incidence of acute renal insufficiency due to higher circulating myoglobin higher hemolysis from the increased Angiojet cycles inducing rhabdomyolysis.

Conclusion: PMT with Angiojet is a safe and effective therapy in patients with ALI. However, patients receiving greater than 150 cycles/s were noted to have higher rates of acute kidney injury and mortality. This is likely reflective of increased thrombus burden and higher rates of hemolysis. Acute kidney injury, greater than 150 cycles/s, and COVID-19 infection were the variables with the strongest association to perioperative mortality.