Vascular最新文献

IntroductionAortoiliac disease is a severe manifestation of peripheral artery disease (PAD) that reduces blood flow to the lower limbs, leading to significant morbidity and mortality. Patients with AID frequently present lesions in other arterial territories, particularly in the superficial femoral artery (SFA), which may lead to more challenging and higher risk outcomes in patients. This study aims to evaluate the prognostic value for major adverse cardiovascular events (MACE) of SFA disease in patients undergoing aortoiliac revascularization.MethodsThis prospective cohort study included all consecutive patients who underwent elective aortoiliac revascularization between January 2013 and September 2022 at both a central and a district hospital, representing two healthcare facilities within the Portuguese Health System. Only patients with aortoiliac Transatlantic Inter-Society Consensus (TASC) II type D lesions were included, excluding those with aortoiliac aneurysmal disease. Moreover, patients with severe multivessel disease in other arterial areas, apart from the aortoiliac artery and SFA, were excluded. Patient demographics, clinical characteristics, and procedural details were collected. Outcomes were assessed in the first 30 days post-procedure and during long-term follow-up. Statistical analyses included Kaplan-Meier survival curves and multivariate Cox regression.ResultsA total of 133 patients were included, with a mean age of 62.3 ± 9.23 years; 94.0% were male, and a median follow-up of 61 [IQR: 55.0-67.0] months. SFA disease was present in 60.9% of patients and was associated with hypertension (p = .025), coronary artery disease (p = .005), congestive heart failure (p = .020), and age (p = .008). Patients with SFA disease had a lower 30-day ankle-brachial index (ABI) (p < .001), smaller post-surgery ABI variation (p = .003), longer hospital stays (p = .005), and higher rates of major adverse limb event (MALE) (p = .007). Survival analysis demonstrated increased long-term MALE, MACE, and all-cause mortality in patients with SFA disease. Multivariable analysis confirmed SFA disease as a significant predictor of all-cause mortality (HR = 2.046 [1.042-4.443] p = .048) and suggested a trend towards increased risk of MACE (HR = 1.542, [0.866-3.101], p = .075).ConclusionThis study identifies SFA disease as a critical prognostic marker for adverse cardiovascular outcomes in patients undergoing aortoiliac revascularization. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings and improve patient management strategies.

ObjectiveWe suspect that the May-Thurner syndrome (MTS) is the main etiology of secondary varicose veins of the lower extremities (VVLE). However, there is no definitive agreement on the priority and necessity of relieving iliac vein compression when treating patients with VVLE and MTS.MethodIn this study, according to the results of anterograde venography of lower extremity, 99 patients were divided into two groups, namely, simple VVLE (n = 66) and VVLE-MTS groups (n = 33). The patients in the former group only received sclerotherapy, while the patients in later group received the combination treatments of intravascular balloon dilatation, stent placement of iliac vein, and sclerotherapy. After surgery, we applied VVCS score, postoperative recanalization rate, and improvement in clinical symptom to assess therapeutic effects.ResultsVCSS score: At 1 week, 1 month, 3 months, and 6 months after operation, there were significant differences between group A and group B (p < 0.01), the difference of VCSS: compared with preoperation, there was statistical difference between group A and group B at 1 week after operation (p < 0.01), there was no statistical difference 6 months after operation (p = 0.052); Postoperative recanalization: cumulative trunk recanalization events 6 months after surgery There was no statistical difference between (p = 0.192) and branch recanalization events (p = 0.207). When the two events were combined to increase the positive rate, no statistical difference was found. However, after stratifying patients, mild (CEAP2-3) and moderate (CEAP4) patients were obtained. There was no statistical difference in the incidence of recanalization events between the two groups, but there was a statistical difference between severe (CEAP5-6) groups (p = 0.025).ConclusionIt was great of importance and necessity of solving iliac vein compression prior to treating VVLE when handling patients with VVLE and MTS, especially for the cases with high CEAP score.

BackgroundDisseminated cancer may complicate decision-making processes for major surgical interventions, including endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). However, the postoperative outcomes of EVAR in patients with disseminated cancer have not been well-established. This study aimed to explore the impact of preoperative disseminated cancer on 30-day outcomes of non-ruptured EVAR.MethodsPatients who underwent infrarenal EVAR were identified in ACS-NSQIP targeted database from 2012 to 2022. Exclusion criteria included age <18 years, ruptured aneurysm, acute intraoperative conversion to open repair, and emergency cases. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without preoperative disseminated cancer. Thirty-day postoperative EVAR outcomes were examined.ResultsThere were 154 (0.80%) patients with disseminated cancer who underwent non-ruptured EVAR. Meanwhile, 19,109 patients without disseminated cancer went under EVAR, where 462 of them were matched to all patients with disseminated cancer. After propensity-score matching, patients with and without disseminated cancer had comparable mortality rates (5.19% vs 4.76%, p = 0.83). However, patients with disseminated cancer had higher lower extremity ischemia (2.60% vs 0.43%, p = 0.04), unplanned reoperation (9.74% vs 3.90%, p = 0.01), and 30-day readmission (19.48% vs 10.61%, p = 0.01).ConclusionDisseminated cancer is significantly more prevalent among patients undergoing EVAR than the general population (0.05%), likely due to shared pathophysiology between AAA development and the incidence and progression of cancer. While EVAR is relatively safe in terms of short-term outcomes in patients with disseminated cancer, the long-term prognosis for these patients needs further investigation.

ObjectivesCombined aneurysmal and occlusive disease presents a challenging clinical problem often treated with a hybrid combined open and endovascular approach. Gluteal compartment syndrome is a rare but serious complication following vascular surgical intervention.MethodsWe present the case of a 77-year-old man who underwent hybrid repair of an iliac aneurysm and chronic limb-threatening ischemia with associated rest pain. Following an uneventful repair, in the early postoperative period, he developed severe left buttock pain with an isolated lactic acidosis and elevated creatine kinase. He was expeditiously diagnosed with left gluteal compartment syndrome and underwent operative exploration with fasciotomy and subsequent delayed primary closure.Results and ConclusionsGluteal compartment syndrome is a rare complication of hybrid iliac artery repair; however, early recognition and treatment may avoid the potential long-term morbidity. The patient in this case presentation recovered uneventfully and was shown to have complete aneurysmal exclusion with resolution of his occlusive symptoms.

ObjectivesTraditionally, acute mesenteric ischemia studies are performed by utilizing an open superior mesenteric artery (SMA) occlusion, which is an invasive technique with potentially devastating effects. A new endovascular technique for SMA occlusion using a catheter-balloon system was designed and compared to the open SMA occlusion to test its efficacy and animal safety.MethodsAll animals underwent open instrumentation of the superior mesenteric vein (SMV) for blood flow monitoring. The animals were grouped into an open SMA occlusion technique group and an endovascular SMA occlusion group. The open SMA occlusion technique group involved exposure of the SMA via left medial visceral rotation with vascular clamping. In the endovascular group, an endovascular balloon was placed in the SMA and inflated to produce occlusion.ResultsComplete cessation of flow to the SMV was observed in the endovascular group, compared to the residual SMV flow in the open occlusion group. Following a 30-min post-occlusion period, the MAP in the endovascular group increased, compared to a decline of MAP in the open occlusion group.ConclusionsThis study indicates the endovascular technique provides a more potent SMA occlusion, with insignificant consequences on the overall health of the animal, in contrast to the open vascular clamping.

ObjectivesPelvic congestion syndrome (PCS), often underdiagnosed, is a cause of chronic pelvic pain in women and is frequently associated with pelvic varicose veins. Endovascular embolization is an established treatment, traditionally performed via femoral or jugular access. However, these approaches may carry higher risks of complications. This study aimed to evaluate the safety, feasibility, and clinical outcomes of using basilic vein percutaneous access for pelvic vein embolization in patients with PCS.MethodsA retrospective cohort study was conducted on 292 women of reproductive age with symptomatic PCS who underwent pelvic varicose vein embolization using percutaneous access via the distal third of the right basilic vein. The study spanned from 2018 to 2023 and was carried out at two hospitals in Bogotá, Colombia. Inclusion criteria comprised chronic pelvic postcoital pain and Doppler-confirmed pelvic varicosities with reflux diameters >6 mm. Data collected included demographics, CEAP and Symptoms-Varices-Pathophysiology classifications, intraoperative details (access approach, duration, coil usage, complications), and postoperative outcomes (symptom resolution, complications, reintervention, ICU/hospital stay, and mortality). Follow-up evaluations were conducted at 15 days, 3 months, and 6 months post-procedure. Descriptive statistics were used for analysis. A detailed description of the surgical technique used for basilic vein access and embolization was included.ResultsAll 292 procedures were successfully performed using basilic vein access with no access-related complications such as bleeding, thrombosis, or hematoma. The average surgical duration was 41.1 min (SD = 4.1), and a mean of 2.6 coils (SD = 0.7) was used per case. The left gonadal vein was embolized in all patients, with additional embolization of the right gonadal (68.8%) and hypogastric veins (6.8%) when indicated. Only one patient (0.3%) experienced a coil migration resulting in pulmonary embolism, requiring reintervention and a short ICU stay. No mortalities were reported. Symptom resolution was achieved in 278 patients (95.2%), indicating high procedural effectiveness.ConclusionsBasilic vein access is a feasible and safe alternative for pelvic vein embolization in patients with PCS. This approach demonstrated excellent technical success, a low complication rate, and high symptom resolution, with the added benefits of shorter procedure time and reduced coil usage compared to traditional access routes. These findings suggest potential procedural and resource efficiency advantages. However, due to the study's retrospective nature and lack of comparative controls, prospective studies are necessary to further assess the long-term efficacy and cost-effectiveness of basilic access in comparison to femoral and jugular approaches. Establishing standardized guidelines for vascular access in PCS treatment could enhance outcomes and procedural safety.

ObjectivesTo evaluate efficacy and safety of percutaneous-endovascular aneurysm repair (p-EVAR) where large-bore access puncture holes were closed with a suture mediated closure device (SMCD) in all eligible patients.MethodsA single-center cohort of prospectively collected data in an Internal Quality Control Registry (IQCR). An "All Comers" cohort of 368 patients with 736 access groins was assessed. All abdominal aortic aneurysm (AAA) patients eligible for p-EVAR after CTA evaluation were included. Patients with stenosis and occlusions requiring vascular Interventions during EVAR were excluded. The groins were stratified into two groups: low-profile (12Fr - 16Fr) and high-profile introducers (18Fr - 20Fr). PerClose ProGlide (Abbott Cardiovascular, IL, USA) and later the newer version PerClose ProStyle (Abbott Cardiovascular, IL, USA) SMCD devices were assessed. Primary endpoints were: Primary ProGlide technical success and Primary assisted percutaneous and non-invasive technical success. Secondary cutdown was an exclusions criterion. Safety endpoints were Freedom from early peri-operative and late 30-day groin access complications requiring vascular surgical intervention.ResultsPrimary technical success was achieved in 66.4 % (473/712) groins. Primary assisted percutaneous and non-invasive technical success was achieved in 32.2 % (229/712) groins. Continuous hemorrhage in 1.4 % (10/712) groins required a cutdown. 98.6 % (712/736) of the groins were successfully closed percutaneously. Median age was 76 years (IQR 71, 80). 78.8 % were male. 92 % (330/368) of the p-EVAR were elective. Median AAA diameter was 57mm (IQR 53, 63). Few groins required surgical intervention. No statically significant differences were found between the PerClose ProGlide and the ProStyle (p < .05).ConclusionsPercutaneous closure is efficient and safe. Low-profile introducers and EVAR components (12Fr - 16Fr) had slightly better primary technical and assisted technical success. 83.5 % of the patient groins were treated with low-profile introducers reflecting the drive in the vascular field toward lower-profile devices. No statistical difference between groups was observed for primary technical success and complication rate.

BackgroundThe management of Common Femoral Artery (CFA) stenocclusive disease presents unique challenges, with debates persisting regarding the optimal treatment strategy between Open Common Femoral Endarterectomy (CFE) and Endovascular Therapy (EVT). This study aimed to compare the efficacy of CFE versus EVT, as well as simple versus advanced EVT (aEVT), using a Bayesian hierarchical framework.MethodsA systematic review was conducted according to PRISMA guidelines by querying PubMed, ScienceDirect, Scopus, and the Cochrane Library for articles published through June 2024. The study included randomized controlled trials and retrospective observational studies with a minimum of 40 patients per cohort. Data were synthesized using a Bayesian random-intercept logistic model to estimate pooled Odds Ratios (OR) for primary patency, freedom from reintervention, and limb salvage.ResultsThe analysis included 10 comparative studies encompassing 1452 patients. Open CFE demonstrated superior outcomes compared to EVT, with a significantly reduced odds of patency loss (OR 0.480; 95% CrI: 0.367-0.626) and lower reintervention rates (OR 0.534; 95% CrI: 0.391-0.718). Limb salvage rates also favored CFE (OR 0.548; 95% CrI: 0.402-0.737). In subgroup analyses, advanced EVT (involving atherectomy) improved primary patency compared to simple EVT (OR 0.520; 95% CrI: 0.306-0.883) but did not statistically significantly reduce the need for reintervention (OR 0.910; 95% CrI: 0.427-1.894).ConclusionOpen CFE remains the gold standard for CFA stenocclusive disease, offering superior long-term durability and limb salvage compared to endovascular interventions. While advanced endovascular techniques improve patency rates compared to simple balloon angioplasty, they fail to significantly reduce reintervention rates, likely due to the biomechanical stress of the femoral region. EVT should be considered a pragmatic option reserved primarily for high-surgical-risk patients.

BackgroundAccurately predicting treatment responses in varicose vein sclerotherapy is crucial for improving patient quality of life and optimizing overall healthcare costs.PurposeOur study aims to accurately predict treatment responses in telangiectasia and reticular vein treatment in lower extremity sclerotherapy, by taking advantage of machine learning's (ML) ability to navigate complex data sets and provide personalized predictions.Materials and MethodsML algorithms were used to predict outcomes in 99 patients with varicose veins. The data set, which included patient characteristics such as age, gender, dosage, and photographs, was analyzed using six ML methods. Response to treatment was divided into three groups as "poor," "moderate," and "good" as a result of clinical visual evaluation.ResultsIndividuals with no prior treatment exhibited a notably higher rate of "Good" responses than those who had received prior treatment. (p < .001) The group receiving a 2% polidocanol dosage showed a higher rate of "Good" responses than the group receiving a 1% polidocanol dosage. (p = .008) XGBoost outperformed other ML algorithms, particularly excelling in predicting "Poor" responses.DiscussionML-based predictive models for assessing sclerotherapy outcomes in varicose veins, uncovering significant efficacy determinants such as dosage and prior treatment history. While pioneering ML in sclerotherapy prediction, our study acknowledges limitations and proposes future research directions, including additional variable incorporation and real-time predictive tool development.

ObjectivesPrimary ruptured abdominal aortic aneurysm (rAAA) survival has been described in a few case reports; however, to our knowledge, there is no existing literature regarding rAAA survival secondary to isolated type II endoleak (T2EL). We aim to report a rare case of non-operative management for a T2EL-associated rAAA.MethodsAn 89-year-old man with a history of endovascular aneurysm repair (EVAR) and persistent T2EL presented with acute abdominal pain and hypotension. Computed topography angiography (CTA) confirmed rAAA with retroperitoneal haematoma. Given his advanced age, comorbidities, and initial preference against surgery, non-operative management was chosen.ResultsAfter resuscitation, the patient remained stable and was discharged 5 days later. A 4-week follow-up CTA showed haematoma resolution, despite mild enlargement of the aneurysm sac. He underwent elective embolization 2- and 4-month post-rupture. One year later, he represented with acute limb ischaemia. At the time, the treated aneurysm remained stable without endoleak.ConclusionThis case study sheds light on the possible different natural history between post-EVAR rAAA and primary rAAA, highlighting the possibility of non-operative management in select hemodynamically stable patients with rAAA after EVAR. While rare, rupture can occur from T2EL, underscoring the need for close surveillance among at risk population.