Vascular最新文献

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.

ObjectivesWe present a clinical case illustrating the feasibility of endovascular treatment of superior mesenteric aneurysm associated with an arteriovenous fistula.MethodsThe patient presented with abdominal pain and diarrhea on admission. Computed tomography angiography revealed an aneurysmal dilatation of the superior mesenteric artery and vein with an arteriovenous fistula. Endovascular therapy successfully managed the condition by reconstructing the artery, closing the fistula, and occluding the aneurysm.ResultsNo aneurysm rupture or endoleak occurred, and the patient's symptoms on admission resolved.ConclusionsEndovascular treatment is a viable alternative for patients with superior mesenteric aneurysms and arteriovenous fistulas, but larger studies and further follow-up are needed to evaluate the safety and long-term efficacy of endovascular treatment.

ObjectivesThis study aims to compare the effectiveness of compression bandages and compression stockings in the treatment of venous ulcers following venous ulcer surgery.MethodA total of 170 patients who underwent venous ulcer surgery were included in this retrospective study. Patients were divided into two groups: the first group used compression bandages, and the second group used compression stockings. In all patients, a sterile cotton dressing from the venous ulcer care kit was first applied directly over the open ulcer to protect the wound bed. Both groups were followed for 3 months. Demographic and clinical characteristics such as age, gender, smoking status, hypertension, peripheral arterial disease (PAD), and diabetes mellitus (DM) were recorded. Primary endpoints included changes in ulcer size, calf circumference, NPRS pain scores, and VCSS scores. Measurements were taken before treatment, at 1 week, at 1 month, and at 3 months. The data were statistically analyzed using appropriate methods.ResultsThe results showed that the compression bandage group had a more significant reduction in ulcer size compared to the compression stocking group. The ulcer size in the bandage group decreased from 16.5 ± 2.2 cm² to 7.9 ± 5.1 cm² after 3 months, while in the stocking group, it reduced from 16.1 ± 1.8 cm² to 9.6 ± 3.1 cm² (p < .001). Additionally, the calf circumference showed a greater reduction in the bandage group, from 41.3 ± 1.9 cm to 35.3 ± 2.9 cm, compared to the stocking group, which showed a reduction from 40.7 ± 1.8 cm to 38.1 ± 2.4 cm (p < .001). NPRS pain scores also decreased more significantly in the bandage group, with scores dropping from 8.0 ± 1.1 to 2.9 ± 2.8, while the stocking group saw a decrease from 7.9 ± 1.2 to 5.4 ± 2.4 (p < .001). VCSS scores improved in both groups, but the bandage group showed a more marked improvement from 19.6 ± 5.1 to 5.2 ± 8.3 compared to the stocking group, which improved from 18.0 ± 5.1 to 7.1 ± 4.7 (p < .001).ConclusionThe findings suggest that compression bandages may be more effective than compression stockings in the post-surgical treatment of venous ulcers, particularly in terms of reducing ulcer size, calf circumference, and pain, as well as improving VCSS scores. These results support the continued use of compression bandages as a primary treatment modality for venous ulcers following surgery.

BackgroundEndovascular recanalization with venous stenting is the preferred treatment for iliofemoral venous obstruction. We reviewed our institutional experience and mid-term outcomes with endovascular therapy for iliofemoral venous obstruction using the Venovo^TM Self-expanding Venous Stent (BARD Peripheral Vascular, Inc., Tempe, AZ, USA).MethodsBetween October 2022 and March 2024, patients with iliofemoral venous obstruction treated with Venovo^TM Self-expanding Venous Stents were retrospectively analyzed. Patients were monitored at 3, 6, and 12 months. The primary endpoint was 12-month primary patency, defined as computed tomography venography-derived stenosis <50% and no target venous revascularization. Secondary endpoints included stent intimal hyperplasia and pain venous clinical severity scores (VCSSs).ResultsWe evaluated 51 limbs from 40 patients (mean age: 61.7 ± 10.7 years; 26 females), including three acute deep venous thrombosis (DVT)cases, six post-thrombotic syndrome (PTS) cases, and 42 non-thrombotic iliofemoral vein lesion cases. All (100%) underwent successful endovascular treatment, with five undergoing combined stent deployment. The interventional operation-related complication rate was 1/51 (1.96%). The median follow-up was 14.6 months (range: 12-18 months). The primary patency rate at 1 year was 90%. Freedom from stent intimal hyperplasia at 12 months was 74.51% (38/51), and 3.92% (2/51) had in-stent stenosis >50%, which was reduced after high-pressure balloon dilation at 6 months. The mean VCSS decreased from a baseline of 13.1.7 ± 3.7 to 3.3 ± 1.6 at 12 months (p < .0001). No complications were noted during follow-up.ConclusionsStenting iliofemoral venous obstruction using the Venovo^TM Self-expanding Venous Stent appears to be safe and effective, with a high rate of 1-year clinical patency and a low reintervention rate.

ObjectivesThe MVP™ Micro Vascular Plug System represents a plug indicated for embolisation of peripheral vasculature. It has a lower profile and can be deliverable through smaller catheters, but it can occlude vessels ≤9 mm. We propose a new embolisation technique based on the use of the MVP™ and detachable coils to embolise vessels of larger calibre.Materials and methodsThrough a 7-F sheath the plug is implanted without detaching it. Then, the vessel is navigated in parallel with a microcatheter through which some coils are detached using the bare portion of the MVP™ to anchor them. This will stabilise the plug avoiding its distal migration. We performed vessel embolisation using this technique in two patients.ResultsTechnical success was 100% with no complications. No MPV™ migration was observed after one month.ConclusionsIn selected cases, this technique allows to expand the indications of the MVP™ when it is undersized to the calibre of the vessel.

ObjectivesCarotid artery dissection (CAD) is a significant cause of strokes in young individuals, leading to severe complications and socioeconomic burdens. Despite antithrombotic therapy being the primary management strategy, optimal treatment for patients with recurrent or worsening symptoms remains undefined. This study aims to describe the characteristics and evaluate the outcomes of conservative versus surgical management in CAD patients.MethodsA total of 23 patients presenting with CAD from November 2014 to December 2021 were reviewed retrospectively. Patient demographics, vascular risk factors, symptoms, imaging results, treatment details, and follow-up information were collected and analyzed. Propensity score matching (PSM) was utilized to enhance comparability.ResultsThe mean age of the patients was 46.4 ± 9.4 years, with a median follow-up of 12 (range 3-90) months. Of the 23 patients reviewed, seven underwent endovascular treatment or open surgery due to unresponsiveness to conservative therapy, while 16 received conservative management. All patients showed regression of symptoms. Surgical patients showed a significant improvement with a 100% patency rate during the follow-up. PS matching adjusted for baseline differences, yielding comparable groups for analysis. No significant difference between treatment approaches was observed in stroke recurrence rates, although surgical intervention showed promising outcomes in symptom resolution and stroke prevention.ConclusionBoth conservative and surgical management of CAD can lead to favorable outcomes. While conservative therapy remains the initial approach and proves effective, surgery appears beneficial and safe in certain cases unresponsive to conservative treatment. Further investigation through larger prospective and randomized trials is necessary to establish its safety and efficacy.