Vascular最新文献

BackgroundThoracic Endovascular Aortic Repair (TEVAR) has revolutionized the surgical treatment for Stanford type B aortic dissection (TBAD). While chronic obstructive pulmonary disease (COPD) is associated with worse outcomes in major surgeries, the specific outcomes of TEVAR in patients with COPD have not been extensively explored. This study aimed to evaluate the 30-day postoperative outcomes of COPD patients undergoing TEVAR for TBAD utilizing data from a multi-institutional national registry.MethodsPatients who underwent TEVAR for TBAD were identified in the ACS-NSQIP database from 2005 to 2022. A 1:3 propensity-score matching was used to match demographics and preoperative characteristics between patients with and without COPD. Thirty-day postoperative outcomes were compared.ResultsThere were 172 (9.56%) and 1628 (90.44%) COPD and non-COPD patients who underwent TEVAR for TBAD, respectively. Patients with COPD had a higher comorbidity burden. After the propensity-score matching, all 172 COPD patients were matched to 440 non-COPD patients. COPD and non-COPD patients had comparable mortality rates (10.12% vs 6.82%, p = .18). However, COPD patients had a higher risk of pulmonary complications (20.83% vs 13.18%, p = .02). All other 30-day outcomes were similar between the two groups.ConclusionCOPD patients had 58.04% higher pulmonary complications while all other 30-day outcomes were comparable to their non-COPD counterparts. Therefore, close monitoring and timely intervention for pulmonary complications in COPD patients can be important after TEVAR for TBAD. Future studies should investigate long-term outcomes among these COPD patients.

ObjectivesPost-reperfusion compartment syndrome is an emergency consequence following revascularization of acute limb ischemia. Fasciotomy is the gold standard treatment for acute compartment syndrome. Some surgeons perform prophylactic fasciotomy (PF) during the same operation; however, fasciotomy may lead to wound complications and an increased length of hospital stay. This study aims to evaluate the outcomes of prophylactic fasciotomy in our hospital.MethodsThis is a retrospective observational cohort study. We reviewed the data of acute limb ischemia patients at Maharaj Nakorn Chiangmai Hospital, who were diagnosed with non-traumatic acute limb ischemia and received revascularization between January 2006 and August 2022. The primary outcomes are 30-day amputation-free survival (AFS) and overall survival (OS). Propensity score weighting with confounder adjustment was used to balance peri-operative confounders.ResultsFrom our data, there were 56 patients in the PF group and 301 in the non-prophylactic fasciotomy (NPF) group. The 30-day amputation rates were 12.5% and 10% in the PF and NPF groups, respectively (p-value 0.895). The 30-day AFS was similar between the PF and NPF groups, with a hazard ratio (HR) of 0.93, 95% confidence interval (CI) 0.32-2.45, and a p-value of 0.882. The 30-day OS in the PF group was statistically lower than that in the NPF group, HR 4.09, 95% CI 1.55-10.77, and a p-value of 0.004. The 1-year and 5-year AFS were not significantly different between the PF and NPF groups. However, the 1-year and 5-year OS were lower in the PF group compared to the NPF group, with HR 3.44, 95% CI 1.37-8.65, and a p-value of 0.009, and HR 3.04, 95% CI 1.24-7.45, and a p-value of 0.015, respectively. Fasciotomy wound infection rates were higher in the PF group compared to the NPF group, 5.5% versus 1.7%, respectively, p-value 0.017. Other clinical outcomes did not show significant statistical differences.ConclusionsProphylactic fasciotomy may not improve amputation-free survival (AFS) but increases mortality, particularly within the first 30 days, even in some high-risk patients. The use of prophylactic fasciotomy should be limited to cases where it is clearly indicated.

ObjectivesThe aim of this study was to report 2-year outcomes of interwoven nitinol (Supera^TM) stent-assisted arteriovenous fistula (AVF) maturation in patients who presented with non-matured AVF.MethodsWe reviewed the clinical data of 20 patients who presented with non-matured AVF (19 patients with brachiocephalic AVF and 1 patient with radiocephalic AVF) and underwent balloon angioplasty followed by Supera^TM stenting in the cephalic vein for long-term hemodialysis between January 2017 and January 2022. The outcomes were evaluated in these patients in terms of technical success, post-intervention complications, reintervention, and cumulative patency (6 months, 1 year, and 2 years).ResultsThe study included 20 patients who presented with non-matured AVF. The mean age of the patients was 65 years (range, 40-85). The Supera^TM stents of size 6.5 mm were used in 15 patients (75%), and those of 7.5 mm and 5.5 mm were used in 4 (20%) and 1 (5%) patient, respectively. The average stent length was 99.5 mm (range, 80-120). Technical success was achieved in all patients. Early use within 1 week by needling at the Supera^TM stent segment (cannulation zone) was successful in all patients without any complications. The mean follow-up time was 24.5 months. During the follow-up period, reinterventions to maintain the function of AVF were performed in 8 patients (40%) (7 patients with juxta-anastomotic stenosis, 1 patient with in-stent restenosis). The reintervention rate was 0.39 procedures per patient per year. The primary patency at 6 months, 1 year, and 2 years were 85.5%, 62.6%, and 54.2%, respectively. The assisted primary patency at 6 months, 1 year, and 2 years were 95%, 84.5%, and 78.8%, respectively.ConclusionsThe use of the Supera^TM stent to improve the AVF maturation rate was associated with acceptable outcomes at 2 years. Its benefit over other strategies was the early use of the access for hemodialysis.

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.

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.

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.