Vascular最新文献

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.

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.

ObjectiveSuperior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction.MethodsThis was a single-center, retrospective study that included all patients who underwent SVC reconstruction using femoral vein from January 2000 to December 2023. Follow-up period analysis included reconstruction patency, surgical reinterventions, patient's symptoms, and complications.ResultsTen patients underwent central venous reconstruction or bypass using the femoral vein, with an average age of 51.88 years ± 10.20 years. SVC syndrome was primarily caused by benign etiologies including pacemakers and indwelling central venous catheters. Common presenting symptoms included head or neck fullness and upper extremity edema. The median follow-up duration was 21 months. Primary patency at 1 year was 79%.ConclusionFemoral vein reconstruction presents a promising solution for managing SVC obstruction, offering effective symptom relief and acceptable venous patency rates. Further research including prospective trials and comparative studies is crucial to refining surgical techniques and understanding long-term efficacy in addressing this complex clinical issue.

ObjectivesProximal to mid-term effects of contrast excimer laser atherectomy (ELA) + drug-coated balloon (DCB) versus PTA + drug-coated balloon (DCB) in the treatment of new lesions in the femoral popliteal segment of patients with lower extremity arteriosclerosis and occlusion.MethodsThe clinical data of 105 patients with CT-confirmed femoropopliteal segment lesions (Rutherford grades 3-6) were retrospectively analyzed. According to the computerized randomization method, 58 patients (44 males, mean 72.41 ± 10.58 years) were divided into group A ELA + DCB dilation and 47 patients (35 males, mean 73.83 ± 11.56 years) in group B PTA + DCB dilation. The clinical indexes mainly included the occurrence of Rutherford grade, freedom from target lesion revascularization rate (FTLR), ankle-brachial index (ABI), stage I survival rate, and postoperative complications before, 6 months, and 12 months after surgery and were compared between the two groups.ResultsThe treatment success rate was 100% in all patients. The Rutherford grading at 12 months after operation was significantly improved in both groups, but statistical analysis showed that the improvement was more significant in group A (87.93% vs 72.34%, p = 0.043); ABI (0.77 ± 0.22^abc vs 0.65 ± 0.10^abc, p = 0.001); FTLR (93.10% vs 78.72%, p = 0.031), respectively. First-stage patency rate (91.38% vs 74.47%, p < 0.001),; complications, and adverse events were not statistically significant between the two groups (p > 0.05).ConclusionsELA + DCB significantly improved the 1-year freedom from target lesion revascularization rate and stage 1 patency rate with no significant increase in complications or adverse events.

BackgroundAs a type of atherosclerotic lesion affecting the peripheral vascular system, peripheral arterial disease (PAD) has an elevated disability rate and seriously affects patients' quality of life. Estimated pulse wave velocity (ePWV) is an alternative indicator of pulse wave velocity and is closely linked with atherosclerosis. However, the link between ePWV and PAD is unelucidated.ObjectivesThis research was undertaken to dissect the linkage between ePWV and PAD.MethodsThis project enrolled 6250 participants in the NHANES between 1999 and 2004. The linkage between ePWV and PAD and its possible influencing factors were explored by constructing a weighted logistics regression model and subgroup analysis. In addition, the threshold effect analysis and restricted cubic spline (RCS) model were utilized to evaluate the non-linear link.ResultsThe weighted logistic regression model demonstrated a great positive linkage between ePWV and PAD risk in the fully adjusted model (OR = 1.29, 95% CI: 1.18-1.42, p < .001). There was a significant nonlinear link between ePWV and PAD. When ePWV was higher than 9.297, the risk of PAD increased significantly (OR = 1.03, 95% CI: 1.02-1.04, p < .001). No significant linkage was detected when the value was below this threshold. Additionally, the subgroup analysis further demonstrated that ePWV had a stronger positive link with PAD in the elderly population (age ≥60 years) and in people with BMI ≤30.ConclusionePWV is an effective predictor of PAD risk especially in the elderly and non-obese population.

ObjectiveThe aim of this study was to investigate the timing of assessing the maturation of arteriovenous fistula (AVF) and the diagnostic efficacy of two ultrasound assessment criteria in determining the maturation of AVF.MethodsWe collected clinical data on 227 patients with end-stage renal disease who were first diagnosed at our institution between February 1, 2023 and February 1, 2024, and were followed up regularly for 12 weeks post-AVF creation, with the diameter of the draining vein and the brachial artery volume flow (VF) recorded at 1 day, 2, 4, 6, 8, 10, and 12 weeks post-operation. We focused on the time of AVF maturation, and ultrasonographic diagnostic criteria 1 (the vein diameter was ≥4 mm, and the brachial artery VF was >500 mL/min, referred to as the "Rule of 4") and ultrasonographic diagnostic criteria 2 (the vein diameter was ≥5 mm, and the brachial artery VF was> 500 mL/min, referred to as the "Rule of 5") were used to evaluate the maturation of AVF. And compared with clinically maturation criteria to understand the correlation, consistency, and diagnostic efficacy.Results1. The venous diameter and brachial artery VF of AVF showed an upward trend, and increased significantly in 1 day to 6 weeks postoperatively (p < .05),especially between 1 day and 2 weeks, while no significant difference in the increases at 6-12 weeks; 2. Logistic regression analysis showed that venous diameter (OR = 19.589 , 95% CI 1.560-245.979, p = .021) and brachial artery VF (OR = 1.024 , 95% CI 1.005-1.042, p = .011) at 6 weeks were the independent correlates affecting AVF maturation; and the optimal thresholds were 4.08 mm (sensitivity 88.10%, specificity 70.00%) and 472.50 mL/min (sensitivity 93.20%, specificity 84.00%), respectively; 3. Compared with clinical maturation, the two ultrasonographic diagnostic criteria at 6 weeks postoperatively were correlated with clinical maturation, and the specificity of both was 100%, with "Rule of 4" having a sensitivity of 79.66%, an accuracy of 84.14%, and a concordance kappa = 0.633, while "Rule of 5″ had a sensitivity of 31.63%, an accuracy of 46.69%, and a concordance kappa = 0.169; and the area under the ROC curve (AUC) for "Rule of 4″ was higher than that for "Rule of 5" (0.898 vs. 0.658, p < .001).ConclusionSix weeks postoperatively may be the best timing for an ultrasound assessment of AVF maturation, and the "Rule of 4" ultrasound assessment criteria was more suitable for clinical judgment of AVF maturation.

BackgroundLower extremity peripheral arterial disease (LEAD) is characterized by the narrowing and occlusion of arteries in the lower extremities. The most severe form of LEAD is chronic limb-threatening ischemia (CLTI), which carries a poorer prognosis for major amputation. The systemic immune-inflammation index (SII) is an index developed to simultaneously reflect the inflammatory and immunothrombosis status of patients, based on platelet counts and the neutrophil-to-lymphocyte ratio.ObjectiveOur study aimed to investigate the relationship between elevated SII and major limb amputation.MethodThe study included 140 patients with foot wounds (Rutherford 5 or 6) due to LEAD who were scheduled for endovascular intervention between 2018 and 2023. Major amputation was required in 27 patients (19.2%). The neutrophil-to-lymphocyte ratio (2.1/2.8/3.8 vs 3.8/6.6/9.3, p < .001), platelet-to-lymphocyte ratio (103.8/128.8/162.9 vs 132.8/212.3/314.6, p < .001), and SII (527/720/1055.5 vs 1108/1951/3807, p < .001) were higher in the major amputation group. ROC curve analysis determined that the optimal cut-off value for SII to predict major amputation in LEAD patients was 1018, with a sensitivity and specificity of 81% and 73%, respectively (AUC: 0.84, 95% CI: 0.74-0.92, p < .001). Logistic regression analysis showed that high SII (OR = 1.001, 95% CI = 1-1.001, p = .009) was identified as an independent predictor of major amputation in LEAD patients.ConclusionThis study establishes that a high SII value is associated with major amputation in LEAD patients with foot wounds.ResultSII is a valuable and straightforward parameter for predicting major amputation risk and guiding treatment decisions in LEAD patients.

ObjectiveThis study aims to assess the clinical value of a novel high-precision iliac vein pressure measuring device to diagnose and treat iliac vein compression syndrome.MethodsA total of 38 patients with clinically confirmed iliac vein compression syndrome (all lesions on the left side) were selected. The iliac vein pressure and pressure recovery time (time taken for pressure to return to resting levels) were measured in four states: rest, affected limb elevation, ankle extension and flexion, and gastrocnemius muscle compression. Bilateral comparisons and pre- and post-treatment assessments were conducted.ResultsThe left iliac vein pressure in the four states (42.40 ± 16.08 mmH₂O, 51.23 ± 17.63 mmH₂O, 70.26 ± 25.55 mmH₂O, and 111.47 ± 58.78 mmH₂O) and pressure recovery time (25.57 ± 10.65 s) were significantly higher compared to the right iliac vein pressure (30.67 ± 7.46 mmH₂O, 36.55 ± 8.59 mmH₂O, 44.84 ± 11.17 mmH₂O, and 52.96 ± 14.06 mmH₂O) and recovery time (18.92 ± 21.07 s) (p = .000). The pressure in patients with left iliac occlusion (179.07 ± 31.64 mmH₂O) was significantly higher than in patients with stenosis (79.91 ± 33.54 mmH₂O) (p = .000). In eight patients who underwent intraluminal iliac venous therapy, postoperative pressure (37.29 ± 7.53 mmH₂O, 44.74 ± 5.10 mmH₂O, 53.76 ± 5.36 mmH₂O, and 61.96 ± 7.27 mmH₂O) and pressure recovery time (20.88 ± 5.67 s) significantly improved compared to preoperative measurements (50.53 ± 8.21 mmH₂O, 60.03 ± 7.50 mmH₂O, 96.88 ± 11.67 mmH₂O, 177.11 ± 22.40 mmH₂O, and 35.50 ± 6.95 s) (p < .01). Despite improvements, postoperative left iliac pressure remained significantly higher than the right iliac pressure in different states (p < .05). The left iliac vein pressure increased significantly during ankle extension and flexion, as well as gastrocnemius muscle compression compared to resting and elevated limb states (p < .05).ConclusionThe innovative high-precision iliac vein pressure measuring device enables rapid and accurate quantification of iliac vein pressure. As a functional diagnostic method, it holds considerable clinical value in diagnosing iliac vein compression syndrome and evaluating treatment efficacy.

BackgroundEndovascular intervention by means of thrombolysis is emerging as a promising management of Acute Aortic Occlusion (AAO). This study aims to evaluate the outcomes of endovascular thrombectomy for AAO cases in a single-center tertiary hospital in Indonesia.MethodsWe review retrospectively AAO patients treated by Rheolytic thrombectomy ± stenting or TEVAR at our referral center from 2011 to 2024. Clinical characteristics and outcomes were analyzed independently and in correlation to one another.ResultOut of 21 episodes in 19 patients, AAO was correlated with thromboembolism in 57.1 %, in situ thrombosis in 23.8%, and malperfusion syndrome in 19% of patients. Most prevalent comorbidities found were coronary arterial disease, hypertension, heart failure, and atrial fibrillation. Method of revascularization were Rheolytic thrombectomy (12), covered stent (5), catheter-directed thrombolysis (2), and TEVAR (4) with an average 90.9% success rate. In-hospital mortality was 21% and did not vary significantly according to etiology (thromboembolism 30% vs in situ thrombosis 20%) except for malperfusion syndrome 0% which comprised of four patients. All fatality occurred among patients with history of coronary artery disease and one failed revascularization case required urgent amputation (5.3%). Average length of stay was 8.67 ± 5.31 days.ConclusionBased on our data, thromboembolism remained highly associated with occurrence of AAO. Endovascular approach by Rheolytic thrombectomy is proven to be comparable or slightly superior in restoring occluded aorto-iliac connection compared to conventional management options. Compared to previous studies, this study establishes a wider representation of AAO cases treated by endovascular means considering the rarity of cases.

ObjectiveTo report a case series of three patients with symptomatic coronary-subclavian steal syndrome (CSSS) and to review the literature on published case series.MethodsWe retrospectively reviewed three cases of CSSS patients treated with open and endovascular surgery at a single center over a period of three decades (1996-2024). A comprehensive review of case series involving more than three patients was also performed.ResultsThe first patient was a 65-year-old male with a 12-year history of coronary artery bypass grafting (CABG), presenting with unstable angina. Coronary angiography revealed a patent left internal mammary artery (LIMA) graft with retrograde flow through the left subclavian artery (LSA) and occlusion at the LSA ostium. He underwent a successful carotid-subclavian bypass, which significantly improved his symptoms. He died 6 years later from heart failure. The second patient was a 73-year-old woman with a 15-year history of CABG and balloon angioplasty of the grafts. She presented with dyspnea, stable angina, and progressive functional decline. Critical stenosis in the LSA was identified, and her symptoms resolved after successful stent placement. She died 6 years later from progressive heart failure. The third patient was a 75-year-old woman with diabetes, hypertension, and heart failure, who also had a history of CABG. She presented with worsening dyspnea, orthopnea, and edema. Imaging revealed occlusion of the circumflex artery graft and severe LSA stenosis. Successful stenting of the LSA alleviated her symptoms and restored normal blood flow from the LIMA graft. She was discharged after 2 days and remains well at the six-month follow-up.ConclusionCSSS should be considered in the differential diagnosis of patients with a history of CABG who present with angina or heart failure. Prompt treatment can lead to significant symptom improvement.