Vascular最新文献

ObjectivesCarotid stenosis plays a significant role in stroke burden. Surgical intervention in the form of carotid endarterectomy or carotid artery stenting is an important stroke risk reduction strategy. Careful patient selection with identification of high-risk individuals is crucial to operative planning given perioperative risks including stroke, myocardial infarction, and death. Machine learning (ML) is a subset of artificial intelligence (AI) consisting of mathematical algorithms that can learn from datasets to perform particular tasks. These algorithms offer a tool for prediction of patient outcomes by analysis of preoperative data leading to improved patient selection. This systematic review aims to assess the use of artificial intelligence in risk stratification for carotid endarterectomy and carotid artery stenting.MethodsPubMed, Web of Knowledge, EMBASE, and the Cochrane Library were systematically searched to identify any articles utilising artificial intelligence in predicting surgical outcomes in carotid endarterectomy or carotid artery stenting. After duplicate removal, all studies underwent independent title and abstract screening followed by quality assessment using the PROBAST tool. Data extraction was then carried out for synthesis and comparison of study outcomes including accuracy, area under receiver operator curve (AUC), sensitivity, and specificity.ResultsAfter duplicate processing, a total of 100 articles underwent title and abstract screening resulting in 11 clinical studies published between 2008 and 2023 that fit eligibility criteria. Surgical outcomes assessed included haemodynamic instability, shunt requirement, hyperperfusion syndrome, stroke, myocardial infarction, and death. Artificial intelligence models were able to accurately predict major adverse cardiovascular events (AUC 0.84), postoperative haemodynamic instability (AUC 0.86), shunt requirement (AUC 0.87), and postoperative hyperperfusion syndrome (AUC 0.95). However, many studies had a high risk of bias due to lack of external validation.ConclusionThis systematic review highlights the potential application of machine learning in prediction of surgical outcomes in carotid artery intervention. However, use of these tools in a clinical setting requires further robust study with use of external validation and larger patient datasets.

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.

BackgroundIt is still challenging to perform high-risk cases, such as acute type A dissection, which frequently require blood transfusions. We created perioperative bloodless protocol, but it includes an optimization to increase the preoperative hemoglobin level enough to tolerate cardiopulmonary bypass. However, it would be impossible to optimize such patients using the strategy in the setting of emergent surgery. We sought to create a surgical strategy in an effort to reduce blood loss for acute type A dissection patients refusing blood transfusion.MethodsWe reviewed the records of two patients in our aortic surgery database who presented with acute aortic dissection and refused blood transfusion. These patients underwent two-staged aortic repair with ascending aortic replacement with debranching to the innominate and left common carotid arteries, followed by thoracic endovascular aortic repair (TEVAR).Results: The two-staged procedure was successfully completed in two patients without any significant complication. The postoperative course was uneventful for both patients.ConclusionTwo-staged aortic repair in patients refusing blood transfusion can avoid circulatory arrest requiring deep hypothermia so as to reduce the risk of coagulopathy and blood loss.