Vascular最新文献

BackgroundSuperior vena cava syndrome (SVCs) is a common complication in hemodialysis patients due to central vein occlusions, often caused by prior catheterizations. Management can be challenging.ObjectiveTo describe a successful endovascular approach to managing SVCs caused by right innominate vein (RIV) occlusion in a hemodialysis patient with a non-functional LeVeen shunt.MethodAn 80-year-old dialysis patient with upper limb edema and vascular access dysfunction was diagnosed with complete RIV occlusion around a long-standing LeVeen shunt. Recanalization was achieved via a percutaneous approach, including angioplasty and placement of a balloon-expandable covered stent, leaving the LeVeen shunt in situ to reduce risks.ResultsThe procedure restored venous patency and improved vascular access functionality. Postoperative imaging confirmed excellent stent positioning and reduced venous congestion. At a 6-month follow-up, central vein patency was maintained.ConclusionEndovascular recanalization is a safe and effective strategy for managing SVCs, even with a retained central venous device. This approach preserved vascular access and ensured successful long-term dialysis, offering insights for treating complex venous occlusions.

ObjectiveTo elucidate the short- and long-term mortality, morbidity, and endoleak incidences in the hybrid management of aberrant subclavian artery (ASA).MethodsA systematic review and meta-analysis of 99 articles comprising n = 272 cases using PRISMA were supplemented by Cohen's Kappa for assessor consistency. The analysis involved a random-effect model, odds ratios (ORs) with 95% confidence intervals, tests of heterogeneity, and probability. This review was registered with the International Prospective Register of Systematic Reviews (CRD42023405011).ResultsThe 30-day mortality was 4.6% (95% CI: 1.4%-14.4%) with an overall mortality of 7.3% (95% CI: 2.9%-18.7%) demonstrating a 1.2% increase in mortality per decade of life beyond 60 years. The reported morbidity was 7.6% (95% CI: 3.7%-15.7%) and higher in males albeit higher age (p < .05) (67 vs 59 years). The endoleak incidence stood at 7.8% (95% CI: 3.3%-18.3%) with Type-I the as prominent (48%). Rupture presentation was in 3%, whilst esophageal fistulation (n = 2/3) was associated with morbidity of 66%. Treatment varied, with TEVAR and carotid-subclavian bypass being the most common modality of the choice. The median follow-up was 12 months (IQR, 1-60 months).ConclusionThe observed incidence of mortality, morbidity, and endoleak shows the current role of the hybrid approach in managing ASA. These results emphasize the critical role of detailed surgical planning, combined endovascular and open expertise, and the necessity for a common registry to monitor long-term outcomes.

ObjectivesRuptured mycotic pseudoaneurysms are rare, yet devastating complications that can prove challenging to manage. In immunocompromised populations, highly virulent organisms such as Gemella morbillorum can be especially difficult to combat. Here, we outline our approach to temporizing maneuvers in an emergent setting and definitive revascularization in a 27-year-old with a ruptured mycotic iliac artery pseudoaneurysm from necrosis of her kidney and pancreas allografts.MethodsThe initial staged repair involved covered stenting of the right iliac artery for hemorrhagic control of a ruptured pancreatic allograft arterial anastomosis, explant of ipsilaterally placed renal and pancreas allografts from the right pelvis, and iliac artery reconstruction using left femoral vein. Subsequent abscess formation leading to anastomotic blowout required repeat covered stenting followed by a femoral-femoral arterial bypass with right femoral vein.ResultsThe patient was discharged home with no further vascular events and preserved lower extremity perfusion. They returned to the clinic 1 month following discharge in stable condition with no wound healing or ischemic complications.ConclusionsThe choice of femoral vein as conduit for in-line arterial repair can provide both better long-term patency and resistance to infection than prosthetic bypass material.

BackgroundThe burden of peripheral arterial disease is increasing. Treatment of femoro-popliteal lesions remains challenging despite novel endovascular devices. Drug-eluting stents suppress post-treatment inflammation and reducing neo-intimal hyperplasia to reduce in-stent restenosis.MethodsA multi-centre retrospective 5-years longitudinal study was undertaken to evaluate freedom from clinically driven target limb revascularisation (FF CD-TLR) and patency of Zilver PTX stents in treating symptomatic femoro-popliteal stenotic lesions. Kaplan-Meier survival curves were used to demonstrate FF CD-TLR, primary, primary assisted and secondary patency.ResultsThere were 148 patients and 183 lesions treated with a mean age of 80.3 years and 52% males. The all-cause 5-years mortality was 25%. FF CD-TLR yearly patencies to 5 years were 81%, 67%, 62%, 57% and 52%, respectively, with significantly poorer outcomes for in-stent restenosis, longer stent lengths and lesions at the femoro-popliteal junction. Primary patencies were 63%, 47%, 40%, 34% and 24%, assisted primary patencies were 90%, 75%, 68%, 59% and 48% and secondary patencies were 96%, 94%, 94%, 92% and 92%. Major adverse limb events were 5% at 1-year and cumulative at 5-years was 16%.DiscussionThe clinical outcomes in this study population are comparable to recent publications with smaller cohorts. Our study confirms Zilver PTX has very good primary patency over 5 years with no discernible effect on all-cause mortality in an elderly cohort with particularly long treated lesions. Our results are similar to those seen in younger patients with shorter lesions. Nonetheless, longer lesions required more reinterventions to maintain patency.ConclusionZilver PTX is a safe and durable drug-eluting stent when utilised in the management of femoro-popliteal stenotic lesions with good long-term patency and limited need for re-intervention.

ObjectivesBasilic vein transposition (BVT) surgery is a crucial option for vascular access in hemodialysis patients when other alternatives are unavailable. One of the primary complications affecting the long-term function of arteriovenous fistulas (AVFs) is the development of pseudoaneurysms, often caused by repeated punctures at the same site. This study aims to evaluate whether increasing the length of the basilic vein available for cannulation during the second stage of BVT surgery reduces the risk of puncture-related pseudoaneurysms, thereby improving fistula longevity and functionality.MethodsWe selected 39 hemodialysis patients unsuitable for cephalic vein AVF creation or who had failed brachiocephalic fistulas. Eligibility criteria included a basilic vein diameter of more than 2.5 mm with appropriate venous anatomy confirmed via ultrasound. In the first stage of surgery, the median basilic vein was anastomosed to the superior surface of the brachial artery. One month later, once the vein had matured (diameter ≥4 mm), a second stage was performed, which involved liberating an extended segment of the basilic vein down to the forearm. The basilic vein was then anastomosed end-to-end with the median basilic vein to increase the cannulation area. Patients were followed for 1 year to evaluate outcomes.Results and ConclusionsAll 39 patients successfully underwent the modified BVT technique. Over the 1-year follow-up period, none experienced significant AVF complications, particularly pseudoaneurysm formation. By increasing the usable length of the basilic vein for cannulation, multiple puncture sites were available, reducing the risk of repeated needle insertions at the same site. The modified BVT technique shows promise in reducing the risk of pseudoaneurysm formation and improving AVF patency, potentially enhancing the longevity and functionality of AVFs in hemodialysis patients. Further studies are necessary to confirm the efficacy of this technique in larger patient populations.

ObjectivesAlthough the endovascular management of infrarenal abdominal aortic aneurysms (AAAs) is widely performed, many studies have shown better long-term results with open graft repairing, mostly focusing on the classical open repair with midline access. This study aims to evaluate long-term results comparing EVAR (endovascular aneurysm repair) and surgical open repair with retroperitoneal access associated with ERAS (Enhanced Recovery After Surgery) protocol.MethodsA retrospective analysis of 156 patients treated for AAA between 2015 and 2018 was conducted. Clinical and demographic characteristics of the two groups were homogeneous except for age, which was significantly higher in patients belonging to the EVAR one, and for previous laparotomies. A total of 100 patients (58.7%) underwent open retroperitoneal repair (ORR group), and 56 (42.3%) underwent EVAR. A mean of 51 ± 28 months of follow-up was conducted. This study aims to evaluate long-term survival by comparing EVAR (endovascular aneurysm repair) and surgical open repair with retroperitoneal access associated with ERAS (Enhanced Recovery After Surgery) protocol. Secondary aims evaluate differences between the two techniques regarding late complications, need for re-interventions, and perioperative results.ResultsFreedom from all-cause mortality, calculated with Kaplan-Meier survival curves equalizing the two population with a Covariate Propensity Score, showed significant better survival rates at 1, 3, and 5 years in ORRs then in EVARs. Late complications (>30 days) and need for late re-intervention rates were greater in the EVAR group (6 late re-interventions needed vs 0 in the ORR group).Perioperative results show longer mean length of hospital stay in patients belonging to the ORR group (5 days vs 2) and significantly higher in-hospital-complication rate.ConclusionsThe long-term comparison between EVAR and open retroperitoneal repair shows significantly better late outcomes in the ORR group. The perioperative course appears significantly better in EVARs but anyway good in ORRs when a perioperative protocol as ERAS is applied.In a selected population of young patients fit for surgery, the retroperitoneal surgical approach should be highly taken into account in the therapeutical choice.

BackgroundChronic total occlusions with ambiguous proximal caps present a significant challenge in endovascular interventions of patients with Buerger's disease.ObjectiveWe aimed to evaluate the effectiveness of transpedal retrograde wire just marker technique in patients with Buerger's disease presenting proximal cap ambiguity and flush occlusions.MethodsSeventeen patients with the diagnosis of Buerger's disease who had below the knee artery chronic total occlusions with ambiguous proximal caps were enrolled. Procedural success, post-intervention Rutherford stage, wound scores, pedal loop scores, and amputation rates were recorded.ResultsFinal study group consisted of 13 patients after exclusion of 4 patients due to pedal loop formation failure and severe vasospasm preventing equipment advancement. Post-intervention angiographic success rate was 100%. The post-intervention Rutherford stage showed excellent improvement (mean preprocedural Rutherford stage = 5 vs mean post-intervention Rutherford stage = 2; p = 0.003). Additionally, the average Saint Elian Wound Score System (SEWSS) decreased significantly (Preprocedural 14.9 ± 4.0 vs Postprocedural 11.3 ± 4.7, p < 0.001) after the interventions. Two patients had a major amputation during the follow-up indicating that higher post-intervention pedal loop scores are associated with higher amputation rates.ConclusionsTranspedal retrograde wire just marker technique is an effective and practical method for revascularization of below the knee artery occlusions with ambiguous proximal caps. Including pedal loop angioplasty as a routine part of this technique can significantly increase blood supply to the pedal arch., thereby enhancing the likelihood of wound healing.

ObjectivesRenal artery aneurysm (RAA) is a rare condition among visceral aneurysms, often asymptomatic and incidentally discovered through imaging. Surgical or interventional procedures are utilized for treatment, depending on the aneurysm's size, morphology, and the patient's physical condition, to prevent rupture.MethodsA patient was admitted with a giant asymptomatic RAA, measuring a maximum diameter of 11 cm on a serendipitous occasion.ResultsWe successfully accomplished a full embolization treatment for the aneurysm, exclusively utilizing inflow tract embolization techniques. Six months post-treatment, a follow-up abdominal ultrasound examination demonstrated a notable decrease in the aneurysm's diameter, signifying the positive outcome of our intervention.ConclusionsThis approach offers a feasible alternative in challenging cases, especially when traditional surgical methods are not feasible or carry significant risks.

ObjectivesEndovascular therapy (EVT) for calcified nodules in patients with peripheral artery disease (PAD) remains challenging in achieving favorable outcomes. This study aims to investigate the effectiveness of orbital atherectomy (OA) for calcified nodules using an IM catheter to precisely control the device and achieve optimal engagement with the target lesion.MethodsWe performed EVT for a calcified nodule in the right common femoral artery using an OA. Due to the large vessel size, controlling the OA to effectively engage the lesion was challenging. To overcome this, we utilized an IM catheter to guide the OA toward the target lesion.ResultsThe use of the IM catheter successfully directed the OA to the calcified lesion, resulting in significant lumen enlargement. The procedure was completed without any complications, and the OA achieved effective debulking of the calcified nodule.ConclusionsThe combination of OA and IM catheter facilitated effective contact with the target lesion, improving the performance of the debulking device. This approach may enhance the management of calcified lesions in large-diameter arteries during EVT, potentially leading to better clinical outcomes.