Vascular最新文献

Introduction: Most existing management strategies for spinal cord ischaemia (SCI) after thoracic endovascular aortic repair (TEVAR) are invasive in nature, including intravenous vasopressors, cerebrospinal fluid drainage, and segmental artery embolization. Non-invasive pharmacological adjuncts have been described without established effectiveness. Clinical Case: This case report describes the use of midodrine, an alpha 1-adrenoreceptor agonist, as a rescue therapy adjunctive to phenylephrine to successfully reverse post-TEVAR delayed paraplegia in a 73-year-old patient with ruptured thoracic aortic aneurysm. The initial episode of paraplegia was completely reversed with lumbar drainage, while the second episode was effectively corrected with phenylephrine and subsequently midodrine alone. He had complete neurological recovery, and could mobilize independently. Conclusion: Midodrine is a safe and non-invasive treatment to increase spinal cord perfusion pressure, which could improve or even reverse symptoms of spinal cord ischemia in patients post-TEVAR.

ObjectiveIliac limb branch occlusion after endovascular aneurysm repair (EVAR) creates risk for limb or pelvic ischemia. This study aims to explore the hemodynamic factors associated with eventual iliac branch occlusion after EVAR for abdominal aortic aneurysm.MethodsSix patients with different causes of iliac branch occlusion were selected between January 2013 and December 2023, and computed tomography angiography (CTA) images were acquired at the time of preoperative and postoperative occlusion of EVAR. Specific CTA images were applied for modeling and computational fluid dynamics (CFD) analysis was implemented.ResultsPressure, velocity, wall shear stress (WSS), time-averaged wall shear stress (TAWSS), oscillatory Shear Index (OSI), and relative residence time (RRT) were calculated. Velocity, WSS, and TAWSS were elevated at the stenosis, and pressure, OSI, and RRT were decreased at the stenosis. Streamlines were reduced at stenotic sites. Iliac branch locations that eventually occluded had more disturbed flow compared to non-occluded sites. Both pressure and flow velocity gradient variations are greater on the occluded side than on the non-occluded side.ConclusionsComputational fluid hemodynamic analysis identified consistent flow disturbances associated with eventual iliac limb occlusion following EVAR. These findings suggest that CFD-based hemodynamic assessment may help stratify patients at risk of iliac branch occlusion before clinical manifestation.

ObjectivesCarotid arterial disease is one of the most important causes of stroke and the gold standard in its treatment is surgical endarterectomy. Different approaches have been reported regarding revascularization methods (stent/surgery) and surgical methods (with shunting/with-out shunting) in patients with contralateral carotid stenosis. In this study, revascularization methods and postoperative follow-up of patients with contralateral carotid arterial stenosis in our clinic were investigated.MethodsPatients who underwent carotid endarterectomy in our clinic between 01.04.2019 and 30.04.2024 were retrospectively analyzed. Patients were divided into 4 groups according to contralateral carotid artery stenosis. On the contralateral side; patients with <50% stenosis constituted Group 1, patients with 50-69% stenosis constituted Group 2, patients with 70-99% stenosis constituted Group 3, and patients with total occlusion constituted Group 4. In all patients, the operation was performed with NIRS monitoring. The groups were compared in terms of postoperative neurological events and mortality.ResultsThere were 248 patients, who had undergone carotid endarterectomy during the study period. There were 143 patients in Group 1, 47 patients in Group 2, 44 patients in Group 3, and 14 patients in Group 4. Demographics, preoperative findings and cross clamping times were similar between the groups. All of the operations except 2 with regional anesthesia were performed under general anesthesia. Shunting was required in 6 patients and arteriotomy was closed with patchplasty in 17 patients. In the comparison of postoperative events, there was no statistically significant difference between the groups in the terms of early-term minor (1.4%, 2.1%, 2.3%, and 0, respectively) and major (0.007%, 0, 2.3%, and 0, respectively) neurological events. There were 5 reoperations due to bleeding (3 in Group 1 and 2 in Group 2) 3 mortalities (1 in Group 1 and 2 in Group 3). There was no neurological event and mortality and 1 restenosis in Group 1 in the follow-up period.ConclusionIn carotid artery stenosis, contralateral carotid artery stenosis is not a marker for determining the revascularization method. Performing the operation with standard precautions without deviating from routine practice has similar results to the surgical approach applied in unilateral stenosis. In these patients, the operation might be performed safely with precautions such as cerebral monitoring and not lowering blood pressure during the operation.

BackgroundIt has been shown that fluoroquinolones (FQs) use may be associated with an increased risk of aortic aneurysm (AA) and/or aortic dissection (AD).ObjectivesThe aim of this meta-analysis was to systematically review and summarize the epidemiological evidence on the risk of aortic AA and/or AD following FQs use.DesignSystematic review and meta-analysis.Data Sources and MethodsWe performed a meta-analysis using data from PubMed, Embase, and the Cochrane Library, with research conducted up to March 15, 2025. Cohort studies examining the association between FQs use and AA or AD were included. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A combined HR with 95% CI was calculated using either a random-effects or fixed-effects model, and robustness was assessed using sensitivity analysis. This meta-analysis was registered with PROSPERO (CRD 420251012072).Results11 studies were included, with 81,976,958 participants. The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06-1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24-1.73) and AD (HR = 1.12, 95% CI: 1.04-1.22). In subgroup analysis, the gender subgroup analysis revealed a higher risk of AA/AD for males (HR = 1.16, 95% CI: 1.06-1.27) compared to females (HR = 1.09, 95% CI: 1.00-1.20). Regionally, the risk was higher in America (HR = 1.47, 95% CI: 1.12-1.93) than Europe (HR = 1.08, 95% CI: 0.98-1.19) and Asia (HR = 0.80, 95% CI: 0.61-1.05). Risk associated with FQs use within 90 days (HR = 1.20, 95% CI: 1.13-1.26) was significantly higher, while no significant increase was observed for ≥365 days (HR = 1.00, 95% CI: 0.90-1.12). The presence of hypertension (HR = 1.24, 95% CI: 1.14-1.36) was associated with a significantly higher risk of AA/AD.ConclusionThis meta-analysis demonstrates that the use of FQs is associated with a significant risk of AA/AD. Clinicians should be aware of this risk in patients prescribed FQs, and further research is needed to elucidate the role of FQs in the development of AA/AD.

BackgroundMajor lower limb amputations, often performed as lifesaving procedures in patients with advanced peripheral vascular disease (PVD), are associated with high rates of postoperative complications and reoperations. Identification of risk factors associated with reoperation is crucial for targeted perioperative management. The objective of the study is to identify the factors associated with increased risk of reoperation following major amputation and to develop and evaluate a predictive model for the same.MethodsA prospective observational study was conducted at our tertiary care centre between October 2022 and December 2023. After taking institutional ethical committee clearance, 83 patients undergoing major lower limb amputations (above or below the knee) for PVD were included in study. Demographic, clinical, and radiological variables were collected and analyzed. Reoperation was defined as any additional procedure requiring revision of the stump within 30 days, excluding minor wound interventions. Multivariable binomial logistic regression analysis was performed to identify independent risk factors associated with reoperation.ResultsThe reoperation rate following major amputation was 44.57%, the two common causes were stump necrosis (40.54%) and wound infections (29.72%). On multivariable analysis, age >60 years (OR: 8.26, p = .001) and arterial blockage above the common femoral artery (CFA) (OR: 4.32, p = .038) emerged as significant independent risk factors. The regression model demonstrated moderate predictive strength with a Nagelkerke R² value of 40.9% and good model fit (p = .724).ConclusionAdvanced age and proximal arterial occlusion are significant predictors of reoperation after major amputation. The proposed model offers a practical tool for risk stratification, patient counselling, and surgical planning. Multicentre validation is needed to refine its predictive accuracy.

Background/ObjectivesPrevious studies have reported that inflammatory biomarkers have prognostic value in various fields, including vascular surgery. Biomarkers such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) help identify patients at higher risk for cerebrovascular events, as well as in the treatment and follow-up of patients. There are studies investigating the usefulness of these biomarkers for carotid artery disease. However, data on whether they help predict neurological complications after carotid artery surgery are limited. This study examined the correlation between preoperative carotid arterial stenosis severity, symptomatic presentation, and PLR and NLR levels as potential biomarkers for predicting postoperative neurological complications.MethodsWe retrospectively analyzed the preoperative and postoperative demographics, physical examination, and laboratory results of patients who underwent carotid endarterectomy for carotid artery stenosis in our clinic between January 2019 and January 2023.ResultsWhile our findings did not demonstrate a statistically significant correlation between NLR and PLR levels and postoperative neurological complications, elevated platelet counts were associated with such complications, underscoring the importance of antiplatelet therapy in managing carotid artery disease.ConclusionsThe study linked high platelet counts to postoperative complications and highlights the importance of antiplatelet therapy in managing carotid artery disease. The differences in findings highlight the complexity of stroke prediction and the need for a multifactorial approach.

ObjectivesThis study aimed to assess whether Large Language Models (LLMs), like ChatGPT-4, could simplify discharge summaries for vascular surgery patients while maintaining accuracy and completeness, ultimately improving patient comprehension and engagement in their postoperative care.MethodsIn this cross-sectional multicentric study, discharge summaries from 90 vascular surgery patients across three centers were collected. These were divided into three groups based on patient pathology: aortic pathology, peripheral artery disease, and carotid artery disease. Summaries were processed by LLMs to create patient-friendly versions with a target reading level suitable for a 6th-grade education. The readability of the original and AI-generated summaries was evaluated using the Flesch-Kincaid Grade Level and Ease Score. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Print (PEMAT-P), which evaluates the clarity, organization, and actionable nature of the text. Accuracy and completeness were rated using a 6-point Likert scale and a 3-point Likert scale, respectively. Statistical analyses, including paired-samples t-tests, ANOVA, and post-hoc tests, were performed to assess the differences between the original and AI-modified summaries.ResultsAI-generated summaries demonstrated significant improvements in readability, with a 39.6% reduction in Flesch-Kincaid Grade Level and a 106.37% increase in Ease Score. The mean understandability score based on PEMAT-P was 77.71, while the actionability score was 52.12. Accuracy was rated highly (mean score of 5.21), and completeness had a mean score of 2.61. However, 10.8% of summaries had omissions, and 7.5% had hallucinations, with corrections made in some cases.ConclusionsLLMs like ChatGPT-4 can significantly improve the readability and accessibility of discharge summaries for vascular surgery patients, enhancing their understanding and engagement in postoperative care. While the summaries were accurate and complete, the occurrence of errors suggests the need for further refinement to minimize omissions and hallucinations. These findings indicate that AI can be a valuable tool in improving communication between healthcare providers and patients. Future research should focus on reducing errors and enhancing actionability.

BackgroundThe prevalence of peripheral arterial disease (PAD) is on the rise globally, leading to adverse clinical outcomes. Our aim was to investigate the causal relationship between apolipoprotein and PAD, as well as the potential mediating role of smoking, diabetes, hypertension, myocardial infarction, and ischemic stroke.MethodsWe employed two-sample Mendelian randomization (TSMR) to assess the causal effect of apoB/A1 on the risk of PAD and potential mediators (smoking, diabetes mellitus, hypertension, myocardial infarction, and ischemic stroke), as well as the causal effect of those mediators on PAD. The use of multivariate MR (MVMR) allowed us to explore and quantify the mediating role of these factors in the causal association between apoB/A1 and the risk of PAD.ResultsOur MR analysis showed that each standard deviation increase in apoB/A1 increased the risk of PAD by 46% (OR = 1.460, 95% CI: 1.255-1.697, P = 8.74E-07). Hypertension, myocardial infarction, and ischemic stroke were ultimately recognized as the mediators of the causal relationship between apoB/A1 and PAD, explaining 7.5%, 19.7%, and 62.5% of the causal effect, respectively, and the proportion combined of the three together was 81%.ConclusionsThese studies demonstrated that elevated apoB/A1 increases the risk of developing PAD and that this association may be mediated by hypertension, myocardial infarction, and ischemic stroke.

ObjectivesEmbolizing an abdominal aortic aneurysm sac through a transcaval approach is a novel approach to treat type-II endoleaks that occur following aortic endografting. This study reviews the outcomes of this treatment in one of the few centres in Australia that offers this procedure.MethodsA retrospective cohort study was conducted, including patients who had received transcaval embolisation of type-II endoleak over a 9-year period. The primary outcome was clinical success, defined as the absence of endoleak on post-procedural ultrasonography at 6-weeks, provided the procedure was successfully completed. Other outcomes included clinical success at 1-year, aneurysm size, rupture and aneurysm-related mortality.ResultsTwelve patients with type-II endoleak and AAA sac growth received transcaval embolisation. Technical success was achieved in 91.7% of cases, in which both Onyx 34 and coils were deployed into the sac. Clinical success, defined as an absence of endoleak on ultrasonography 6-weeks after a technically successful procedure, was achieved in 66.7% of patients, none of whom had evidence of endoleak at 1-year post-procedure. In patients whom clinical success was achieved, there was a decrease in sac size during follow-up, from 72.5 ± 13.1 at 6-weeks to 66.0 ± 12.1 at 1-year post-procedure. Aneurysm sac size continued to enlarge if clinical success was not observed, with an average sac size of 72.0 ± 14.1 at 6-weeks increasing to 76.9 ± 15.2 at 1-year. No patients suffered AAA rupture or AAA-related mortality during follow-up.ConclusionsThis study reports a high technical and clinical success rate, with outcomes that could suggest that this procedure could induce sac regression.