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Outcome of different endovascular modalities to treat common iliac artery aneurysms, single center study. 治疗髂总动脉瘤的不同血管内模式的效果,单中心研究。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-07-31 DOI: 10.1177/17085381231192377
Ahmed M Morshed, Mohammed Farag, Khalid A Mowafy, Yasser M Elkiran, Tara M Mastracci

Introduction: Iliac aneurysms occur in 10% of patients with abdominal aortic aneurysms (AAA). There are three different endovascular approaches to their treatment in the context of infrarenal Endovascular Aortic Aneurysm Repair (EVAR): occlusion by coiling the internal iliac, incorporation using an iliac branch device, and delaying repair using a bell bottom limb. We sought to determine outcomes associated with these three strategies in our practice.

Methodology: The study was a combined prospective cohort study with a retrospective arm: prospective patient recruitment was done for 1 year from September 2019 and ended by September 2020, and retrospective data was collected from 2017 to 2019. Demographic, procedural, and imaging data was collected. SPSS was used to analyze data as patients were classified by limbs in four groups: iliac branched, bell bottom, coil and cover technique, and standard treated limbs.

Results: There were 65 male and 4 female patients included in this study incorporating 137 limbs with a mean age of 78 years (SD ± 8 years). Two patients died after discharge (at 3 and 21 months postoperatively, without hospital admission) and five patients were lost to long-term follow-up. Three patients had operations that deviated from the plan: one was an IBD converted to bell bottom, one was an IBD that was converted to coil and cover, and one was a bell bottom that did not seal. Follow-up revealed late type IB endoleak in three bell bottom limbs and one limb treated with coil and cover. Common iliac occlusion occurred in one IBD, three bell bottom limbs, and two limbs treated with coil/cover technique. There were four additional ischemic events (buttock claudication in three and intestinal ischemia in one): all ischemic events occurred in the coil and cover group (p = .001).

Conclusions: Given the small population size examined in this study, there is no statistical difference between treatment groups; however, there was a trend toward bell bottom technique being associated with higher incidence of type IB endoleak. Coil and cover technique was associated with decreased IB endoleak; however, Buttock claudication and intestinal ischemia occurred more significantly in this group. Using IBD may be the best strategy to improve short- and long-term outcomes in patients with iliac aneurysms.

导言:10%的腹主动脉瘤(AAA)患者会出现髂动脉瘤。在髂内主动脉瘤修补术(EVAR)中,有三种不同的血管内治疗方法:髂内动脉瘤盘绕闭塞、使用髂支装置并入和使用钟形底部肢体延迟修补。我们试图确定在我们的实践中与这三种策略相关的结果:该研究是一项前瞻性队列研究与回顾性研究相结合的研究:前瞻性患者招募从 2019 年 9 月开始,到 2020 年 9 月结束,为期 1 年;回顾性数据收集从 2017 年到 2019 年。研究收集了人口统计学、手术和影像学数据。采用SPSS对数据进行分析,按肢体将患者分为四组:髂支、钟底、线圈和覆盖技术、标准治疗肢体:本研究共纳入 65 名男性和 4 名女性患者,共 137 个肢体,平均年龄为 78 岁(SD ± 8 岁)。两名患者在出院后死亡(术后 3 个月和 21 个月,未住院),五名患者失去了长期随访机会。三名患者的手术偏离了计划:一名患者的IBD改成了钟形底部,一名患者的IBD改成了线圈和盖板,还有一名患者的钟形底部没有密封。随访发现,三例钟形底部肢体和一例使用线圈和盖板治疗的肢体出现了晚期 IB 型内漏。一例 IBD、三例钟形底部肢体和两例采用线圈/套管技术治疗的肢体发生了髂总动脉闭塞。另外还有四例缺血事件(三例臀部跛行,一例肠道缺血):所有缺血事件均发生在线圈和覆盖组(P = .001):结论:鉴于本研究的受试者人数较少,治疗组之间没有统计学差异;但是,有一种趋势表明,钟罩底部技术与 IB 型内漏发生率较高有关。线圈和覆盖技术与 IB 型内漏发生率降低有关;但该组中臀部跛行和肠缺血的发生率更高。使用 IBD 可能是改善髂动脉瘤患者短期和长期预后的最佳策略。
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引用次数: 0
A systematic review of simulation training for lower extremity bypass procedures. 下肢搭桥手术模拟训练系统回顾。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-07-26 DOI: 10.1177/17085381231192689
Nadeem Ahmed Siddiqui, Aden Javed, Ammar Pirzada

Objectives: Simulation is used across surgical specialties for skill enhancement. The choice and assessment method of a simulator varies across literature. In the age of endovascular approach, trainees have limited exposure to open lower limb bypass procedures which needs attention. This review aims to assess the utility of simulation training in lower limb bypass surgery using Kirkpatrick's model.

Methods: Using PRISMA statement, we included all the studies done on simulators in lower limb bypass surgical procedures for this systematic review. The primary outcome was to assess the effectiveness of different types of simulation used for lower limb bypass surgery using the Kirkpatrick's model for training evaluation.

Results: An initial search identified 295 articles out of which 7 articles were found to be eligible for this systematic review. A variety of simulators were used including cadavers and synthetic models. Most studies (n=5) found the use of simulation as an effective tool in achieving technical competence. All the five studies we found at level 2 on Kirpatrick's model evaluation.

Conclusion: Most of the existing studies are at level 2 of Kirkpatrick's model which reflects learning changes in trainees after simulation. Feedback mechanism needs to be evolved where the improvement after simulation training can be gauged by its replication in clinical practice and improved patient care practices corresponding to the highest level of Kirkpatrick's model.

目的:各外科专业都使用模拟器来提高技能。不同文献对模拟器的选择和评估方法各不相同。在采用血管内方法的时代,受训者接触开放式下肢搭桥手术的机会有限,这需要引起重视。本综述旨在使用 Kirkpatrick 模型评估下肢搭桥手术模拟训练的实用性:方法:我们采用 PRISMA 声明,将所有关于下肢搭桥手术模拟器的研究纳入本系统性综述。主要结果是使用柯克帕特里克模型对下肢搭桥手术中使用的不同类型模拟器的有效性进行培训评估:初步搜索发现了 295 篇文章,其中有 7 篇文章符合本系统综述的要求。所使用的模拟器多种多样,包括尸体和合成模型。大多数研究(n=5)发现模拟是实现技术能力的有效工具。我们发现所有五项研究在 Kirpatrick 模型评估中都处于 2 级水平:现有的大多数研究都处于 Kirkpatrick 模型的第 2 级,反映了学员在模拟后的学习变化。需要建立反馈机制,通过在临床实践中复制模拟训练和改进病人护理实践来衡量模拟训练后的进步,这与柯帕崔克模型的最高级别相对应。
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引用次数: 0
Commentary to Seed et al. 'What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue'. 对 Seed 等人的评论:"跛行疼痛的正确处方水平是什么?指南中的普遍不一致性,一个令人痛苦的问题"。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-04-05 DOI: 10.1177/17085381231160931
Stefano Lanzi, Lucia Mazzolai
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引用次数: 0
To patch, or not to patch a common femoral artery, that is the question. 要不要修补股总动脉,这是一个问题。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-05-08 DOI: 10.1177/17085381231174702
Damir Vakhitov, Akseli Salminen, Sara Protto

Objectives: There is no strong evidence to support or reject the use of patch angioplasty (PA) after femoral endarterectomy (FE). The current study aimed to assess early postoperative complications and compare primary patency (PP) rates after FE in patients treated with PA versus direct closure (DC).

Methods: This is a retrospective study of patients admitted during 06/2002-07/2017 with signs and symptoms of chronic lower limb ischemia (Rutherford categories 2-6). Patients with angiographically confirmed stenoses or occlusions of the common femoral arteries (CFAs) and managed with FE with or without PA were included in the study. Early postoperative wound complications were assessed. The PP analysis was based on imaging-confirmed data. The impact of PA on the patency was evaluated in a confounder-adjusted Cox regression model. PP rates were compared with log-rank between the PA and DC groups using Kaplan-Meier survival analysis in the propensity score-matched (PSM) cohorts.

Results: A total of 295 primary FEs were identified. The patients' median age was 75 years. A total of 210 patients were managed with PA and 85 with DC. Altogether, 38 (12.9%) local wound complications were registered, 15 (5.1%) of which required re-interventions. There were 9 (3.2%) cases of deep wound infection, 20 (7.0%) seromas, and 11 (3.9%) cases of major bleeding, with no significant difference between the PA and DC groups. All of the infected patches were made of synthetic material, and 83% of them were removed. The PP analysis was performed on 50 PSM patient pairs with a median age of 74 years. The median imaging-confirmed follow-up lengths were 77 months (IQR = 47 months) for the PA patients and 27 months (IQR = 64 months) for the DC patients. The preoperative median diameter of the CFA was 8.8 mm (IQR = 3.4). The 5 year primary patency rates of CFAs with a minimum diameter of 5.5 mm managed with PA or DC exceeded 91%, p > 0.05. Female sex was associated with the loss of PP, odds ratio 4.17, p = 0.046.

Conclusions: Wound complications after FE with or without patching are not uncommon and often lead to reoperations. The PP rates of CFAs with a minimum diameter of 5.5 mm and accomplished with or without patching are comparable. Female sex is associated with the loss of patency.

目的:目前尚无有力证据支持或反对在股动脉内膜切除术(FE)后使用补片血管成形术(PA)。本研究旨在评估术后早期并发症,并比较股动脉内膜剥脱术(FE)后使用补片血管成形术(PA)和直接闭合术(DC)患者的一次通畅率(PP):这是一项回顾性研究,研究对象为 2002 年 6 月至 2017 年 7 月期间收治的具有慢性下肢缺血症状和体征(卢瑟福分类 2-6 级)的患者。研究对象包括经血管造影证实股总动脉(CFA)狭窄或闭塞的患者,这些患者接受了FE治疗,无论是否使用PA。对术后早期伤口并发症进行了评估。PP分析基于影像学确认的数据。在混杂因素调整后的 Cox 回归模型中评估了 PA 对通畅性的影响。在倾向评分匹配(PSM)队列中,采用卡普兰-梅耶生存分析法对PA组和DC组的PP率进行对数秩比较:结果:共发现 295 例原发性 FE。结果:共发现 295 例原发性 FE,患者的中位年龄为 75 岁。共有 210 名患者接受了 PA 治疗,85 名患者接受了 DC 治疗。共登记了 38 例(12.9%)局部伤口并发症,其中 15 例(5.1%)需要再次干预。9例(3.2%)伤口深部感染,20例(7.0%)血清瘤,11例(3.9%)大出血,PA组和DC组之间无明显差异。所有感染的补片均由合成材料制成,其中 83% 的补片已被移除。PP 分析针对 50 对 PSM 患者进行,中位年龄为 74 岁。影像学证实的中位随访时间分别为:PA 患者 77 个月(IQR = 47 个月),DC 患者 27 个月(IQR = 64 个月)。术前 CFA 的中位直径为 8.8 毫米(IQR = 3.4)。最小直径为 5.5 毫米的 CFA 在接受 PA 或 DC 治疗后的 5 年初次通畅率超过 91%,P > 0.05。女性性别与 PP 的丧失有关,几率比为 4.17,P = 0.046:无论是否进行修补,FE术后伤口并发症并不少见,而且常常导致再次手术。最小直径为 5.5 毫米的 CFA 在修补或不修补后的 PP 率相当。女性性别与通畅性丧失有关。
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引用次数: 0
Use of steerable sheaths for complex aortic procedures. 使用可转向鞘管进行复杂的主动脉手术。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-05-30 DOI: 10.1177/17085381231174726
Ben Harrison, Richard Bond

Objectives: To demonstrate the ease with which steerable sheaths, designed for cardiac electrophysiological applications, can be used to aid endovascular treatment of a wide range of non-cardiac vascular disease and to assist with target vessel cannulation in branched and fenestrated aortic grafts.

Methods: A retrospective medical chart review was carried out to identify cases from a single vascular surgery unit (2019-2022) where the HeartSpan Steerable Sheath (HSS) (Merit Medical, South Jordan, UT, USA) was utilised to enable endovascular management of complex vascular pathology. A case presentation of branch graft insertion performed entirely via distal access is described and used to help identify pertinent sheath characteristics and technical considerations, and to illustrate the advantages and disadvantages of the design for modified use in target vessel cannulation.

Results: The HSS was used in the endovascular treatment of different vascular pathologies in 15 patients (23 target vessels) where access to the vessels using standard catheters and approaches was not possible. Cannulation and subsequent stenting were successful for 21 of the 23 target vessels in total. Of these cases, the HSS was used as an adjunct for deployment of fenestrated endovascular graft systems when conventional techniques for canulation of target vessels had failed on five occasions. On another four occasions, the HSS enabled full deployment of the entire Zenith® t-Branch™ Thoracoabdominal Endovascular Graft system from an exclusively femoral approach. An additional three cases involved use of the HSS for superior mesenteric artery cannulation in patients with mesenteric ischaemia. The device was also used once in each of the following cases: contralateral common iliac cannulation, cannulation of contralateral internal iliac artery for coil embolisation, and access of a contralateral iliac branched device. There were no stent dislocations and all aortic branches that were patent at the completion of each case remained so 1-year post procedure.

Conclusion: Steerable sheaths designed for cardiac electrophysical applications, like the HSS Introducer, can be successfully utilised for cannulation of challenging target vessels in a wide range of aortic endovascular procedures. This modified approach may salvage cases that would otherwise be considered inoperable in regions of the world where steerable sheaths designed for aortic use are not readily available.

目的证明为心脏电生理应用而设计的可转向鞘可轻松用于辅助各种非心脏血管疾病的血管内治疗,并协助支状和栅栏状主动脉移植物的靶血管插管:我们对病历进行了回顾性分析,以确定单一血管外科单元(2019-2022年)中使用HeartSpan可操纵鞘(HSS)(Merit Medical, South Jordan, UT, USA)对复杂血管病变进行血管内治疗的病例。本文描述了一例完全通过远端入路进行分支移植物插入的病例,用于帮助确定相关鞘的特性和技术注意事项,并说明该设计在靶血管插管中改良使用的优缺点:在无法使用标准导管和方法进入血管的情况下,HSS被用于对15名患者(23条目标血管)的不同血管病变进行血管内治疗。在 23 条目标血管中,共有 21 条成功进行了插管和随后的支架植入术。在这些病例中,有五次在使用传统技术对目标血管进行插管失败的情况下,使用了 HSS 作为辅助工具,用于部署带孔血管内移植系统。另外四次,HSS 使整个 Zenith® t-Branch™ 胸腔腹腔血管内移植物系统能够完全从股动脉入路进行部署。另有三例使用 HSS 为肠系膜缺血患者进行肠系膜上动脉插管。该装置还在以下病例中各使用过一次:对侧髂总动脉插管、对侧髂内动脉插管以进行线圈栓塞,以及对侧髂支装置的接入。没有发生支架脱位的情况,每个病例术后一年,所有主动脉分支均保持通畅:结论:为心脏电生理应用设计的可转向鞘(如 HSS Introducer)可成功用于各种主动脉血管内手术中具有挑战性的靶血管插管。在世界上还没有设计用于主动脉的可转向鞘的地区,这种改良方法可能会挽救那些被认为无法手术的病例。
{"title":"Use of steerable sheaths for complex aortic procedures.","authors":"Ben Harrison, Richard Bond","doi":"10.1177/17085381231174726","DOIUrl":"10.1177/17085381231174726","url":null,"abstract":"<p><strong>Objectives: </strong>To demonstrate the ease with which steerable sheaths, designed for cardiac electrophysiological applications, can be used to aid endovascular treatment of a wide range of non-cardiac vascular disease and to assist with target vessel cannulation in branched and fenestrated aortic grafts.</p><p><strong>Methods: </strong>A retrospective medical chart review was carried out to identify cases from a single vascular surgery unit (2019-2022) where the HeartSpan Steerable Sheath (HSS) (Merit Medical, South Jordan, UT, USA) was utilised to enable endovascular management of complex vascular pathology. A case presentation of branch graft insertion performed entirely via distal access is described and used to help identify pertinent sheath characteristics and technical considerations, and to illustrate the advantages and disadvantages of the design for modified use in target vessel cannulation.</p><p><strong>Results: </strong>The HSS was used in the endovascular treatment of different vascular pathologies in 15 patients (23 target vessels) where access to the vessels using standard catheters and approaches was not possible. Cannulation and subsequent stenting were successful for 21 of the 23 target vessels in total. Of these cases, the HSS was used as an adjunct for deployment of fenestrated endovascular graft systems when conventional techniques for canulation of target vessels had failed on five occasions. On another four occasions, the HSS enabled full deployment of the entire Zenith® t-Branch™ Thoracoabdominal Endovascular Graft system from an exclusively femoral approach. An additional three cases involved use of the HSS for superior mesenteric artery cannulation in patients with mesenteric ischaemia. The device was also used once in each of the following cases: contralateral common iliac cannulation, cannulation of contralateral internal iliac artery for coil embolisation, and access of a contralateral iliac branched device. There were no stent dislocations and all aortic branches that were patent at the completion of each case remained so 1-year post procedure.</p><p><strong>Conclusion: </strong>Steerable sheaths designed for cardiac electrophysical applications, like the HSS Introducer, can be successfully utilised for cannulation of challenging target vessels in a wide range of aortic endovascular procedures. This modified approach may salvage cases that would otherwise be considered inoperable in regions of the world where steerable sheaths designed for aortic use are not readily available.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"957-963"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9540300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anatomical variations of the great saphenous vein at the saphenofemoral junction. A cadaveric study and narrative review of the literature. 大隐静脉在股隐交界处的解剖变异。尸体研究和文献综述。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-05-09 DOI: 10.1177/17085381231174917
Kostas Tepelenis, Georgios Papathanakos, Aikaterini Kitsouli, Alexandra Barbouti, Dimitrios N Varvarousis, Athanasios Kefalas, Nikolaos Anastasopoulos, Georgios Paraskevas, Panagiotis Kanavaros

Objectives: The great saphenous vein is the lower limb's longest and thickest-walled superficial vein. Its anatomy is complex, while its anatomical variations are widespread. This study aimed to illustrate the anatomy and variations of the great saphenous vein at the saphenofemoral junction.

Methods: The study was conducted on 75 fresh-frozen cadaveric lower limbs. Cadavers with evidence of prior leg surgery or trauma and any congenital abnormality or gross deformity were excluded. The saphenofemoral junction was studied in detail with emphasis on the number, incidence, draining pattern of tributaries, and duplication of the great saphenous vein.

Results: Out of the 75 cadaveric lower limbs, 57.3% were obtained from males, and 42.7% were obtained from females. The mean age of the cadaveric lower extremities was 66.6 years (range 42-91). The number of tributaries at the saphenofemoral junction varied from 0 to 7, with a mean of 3.8. The most frequent number of branches was 4-5 in 61.3% of cases. The most consistent tributary was the superficial external pudendal vein, while the posterior accessory great saphenous vein was the least frequent tributary. 80% of the branches drained into the saphenofemoral junction directly (53.3%) or by a common trunk (26.7%%). The most frequent common trunk was the superficial epigastric and superficial circumflex iliac vein (10.7%). The rest 20% of the tributaries drained directly into the common femoral vein. The commonest branch reaching the common femoral vein was the superficial external pudendal vein (10.7%). Duplication of the great saphenous vein was observed in 2.7% of the cases.

Conclusions: There is a significant variation of tributaries at the saphenofemoral junction regarding the number, incidence, draining pattern of branches, and duplication of the great saphenous vein.

目标:大隐静脉是下肢最长、壁最厚的浅静脉。其解剖结构复杂,解剖变异广泛。本研究旨在说明大隐静脉在股隐交界处的解剖结构和变化:研究对象是 75 具新鲜冷冻的下肢尸体。研究对象为 75 具新鲜冷冻的下肢尸体,排除了曾接受过腿部手术或外伤的尸体,以及任何先天畸形或严重畸形的尸体。详细研究了大隐静脉与股动脉交界处,重点是大隐静脉的数量、发生率、支流引流模式和重复情况:在 75 具下肢尸体中,57.3% 来自男性,42.7% 来自女性。尸体下肢的平均年龄为 66.6 岁(42-91 岁不等)。隐股交界处的支流数量从 0 到 7 不等,平均为 3.8。在 61.3% 的病例中,最常见的支流数量为 4-5 条。最稳定的支流是外隐静脉,而最不常见的支流是大隐静脉后支。80%的分支直接(53.3%)或通过共同主干(26.7%)排入大隐股交界处。最常见的共同主干是上腹部浅静脉和髂周浅静脉(10.7%)。其余 20% 的支流直接流入股总静脉。到达股总静脉的最常见分支是浅外阴静脉(10.7%)。2.7%的病例观察到大隐静脉重复:结论:在大隐静脉的数量、发生率、分支引流模式和重复方面,股隐交界处的支流存在明显差异。
{"title":"Anatomical variations of the great saphenous vein at the saphenofemoral junction. A cadaveric study and narrative review of the literature.","authors":"Kostas Tepelenis, Georgios Papathanakos, Aikaterini Kitsouli, Alexandra Barbouti, Dimitrios N Varvarousis, Athanasios Kefalas, Nikolaos Anastasopoulos, Georgios Paraskevas, Panagiotis Kanavaros","doi":"10.1177/17085381231174917","DOIUrl":"10.1177/17085381231174917","url":null,"abstract":"<p><strong>Objectives: </strong>The great saphenous vein is the lower limb's longest and thickest-walled superficial vein. Its anatomy is complex, while its anatomical variations are widespread. This study aimed to illustrate the anatomy and variations of the great saphenous vein at the saphenofemoral junction.</p><p><strong>Methods: </strong>The study was conducted on 75 fresh-frozen cadaveric lower limbs. Cadavers with evidence of prior leg surgery or trauma and any congenital abnormality or gross deformity were excluded. The saphenofemoral junction was studied in detail with emphasis on the number, incidence, draining pattern of tributaries, and duplication of the great saphenous vein.</p><p><strong>Results: </strong>Out of the 75 cadaveric lower limbs, 57.3% were obtained from males, and 42.7% were obtained from females. The mean age of the cadaveric lower extremities was 66.6 years (range 42-91). The number of tributaries at the saphenofemoral junction varied from 0 to 7, with a mean of 3.8. The most frequent number of branches was 4-5 in 61.3% of cases. The most consistent tributary was the superficial external pudendal vein, while the posterior accessory great saphenous vein was the least frequent tributary. 80% of the branches drained into the saphenofemoral junction directly (53.3%) or by a common trunk (26.7%%). The most frequent common trunk was the superficial epigastric and superficial circumflex iliac vein (10.7%). The rest 20% of the tributaries drained directly into the common femoral vein. The commonest branch reaching the common femoral vein was the superficial external pudendal vein (10.7%). Duplication of the great saphenous vein was observed in 2.7% of the cases.</p><p><strong>Conclusions: </strong>There is a significant variation of tributaries at the saphenofemoral junction regarding the number, incidence, draining pattern of branches, and duplication of the great saphenous vein.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"1116-1121"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9438523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Strain-gauge venous occlusion plethysmography: An objective and non-invasive approach to the evaluation of venous hemodynamics in patients with acute deep-vein thrombosis undergoing post-pharmacomechanical thrombolysis. 应变仪静脉闭塞褶皱成像:对接受药物机械溶栓术后治疗的急性深静脉血栓患者进行静脉血液动力学评估的客观无创方法。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-05-11 DOI: 10.1177/17085381231174951
Hakan Guven

Objectives: Strain-gauge venous occlusion plethysmography (SGVOP) is a means of acquiring hemodynamic data non-invasively, unlike other methods used routinely for the diagnosis and follow-up of venous diseases. The present study compares the plethysmographic data with early- and mid-term routine data of patients with acute deep-vein thrombosis (DVT) who underwent pharmacomechanical thrombolysis.

Patients and method: Included in this retrospective study were 118 patients with acute DVT, who underwent pharmacomechanical thrombolysis between February 2018 and July 2019. Pre- and post-procedure follow-up data including CIVIQ-20 (quality of life), VCSS (Venous Clinical Severity Score), D-Dimer, Doppler USG results, venous capacity (VC), and venous outflow (VO) obtained by SGVOP were recorded and compared.

Results: In all 118 (100%) patients who underwent the procedure, early- and mid-term patency was seen to have been provided on Doppler USG follow-up, and various degrees of venous insufficiency were identified. A statistically significant improvement was observed in VCSS, CIVIQ-20, D-Dimer, VO, and VC measurements, although when the discrepancies between CIVIQ-20 and plethysmographic measurements were examined individually during the 6-month follow-up, nine (13.1%) patients were identified with comorbidities.

Conclusions: Pharmacomechanical thrombolysis is an effective treatment approach for patients with acute DVT. Providing non-invasive objective data supporting the diagnosis and follow-up of venous diseases, the SGVOP approach offers significant benefits and should be considered more frequently as a viable therapy.

目的:应变计静脉闭塞血流搏动图(SGVOP)是一种无创获取血液动力学数据的方法,不同于用于静脉疾病诊断和随访的其他常规方法。本研究比较了接受药物机械溶栓治疗的急性深静脉血栓(DVT)患者的胸廓成像数据与早期和中期常规数据:这项回顾性研究纳入了118名急性深静脉血栓患者,他们在2018年2月至2019年7月期间接受了药物机械溶栓治疗。记录并比较了手术前后的随访数据,包括 CIVIQ-20(生活质量)、VCSS(静脉临床严重程度评分)、D-二聚体、多普勒 USG 结果、静脉容量(VC)和 SGVOP 获得的静脉流出量(VO):结果:在所有 118 名(100%)接受手术的患者中,多普勒超声随访显示其早期和中期静脉通畅,并发现了不同程度的静脉功能不全。VCSS、CIVIQ-20、D-二聚体、VO和VC测量值均有明显改善,但在6个月的随访中,对CIVIQ-20和胸透测量值之间的差异进行单独检查时,发现9名(13.1%)患者存在合并症:结论:药物机械溶栓是治疗急性深静脉血栓患者的有效方法。SGVOP 可提供无创的客观数据,为静脉疾病的诊断和随访提供支持,具有显著的优势,应更多地将其作为一种可行的治疗方法。
{"title":"Strain-gauge venous occlusion plethysmography: An objective and non-invasive approach to the evaluation of venous hemodynamics in patients with acute deep-vein thrombosis undergoing post-pharmacomechanical thrombolysis.","authors":"Hakan Guven","doi":"10.1177/17085381231174951","DOIUrl":"10.1177/17085381231174951","url":null,"abstract":"<p><strong>Objectives: </strong>Strain-gauge venous occlusion plethysmography (SGVOP) is a means of acquiring hemodynamic data non-invasively, unlike other methods used routinely for the diagnosis and follow-up of venous diseases. The present study compares the plethysmographic data with early- and mid-term routine data of patients with acute deep-vein thrombosis (DVT) who underwent pharmacomechanical thrombolysis.</p><p><strong>Patients and method: </strong>Included in this retrospective study were 118 patients with acute DVT, who underwent pharmacomechanical thrombolysis between February 2018 and July 2019. Pre- and post-procedure follow-up data including CIVIQ-20 (quality of life), VCSS (Venous Clinical Severity Score), D-Dimer, Doppler USG results, venous capacity (VC), and venous outflow (VO) obtained by SGVOP were recorded and compared.</p><p><strong>Results: </strong>In all 118 (100%) patients who underwent the procedure, early- and mid-term patency was seen to have been provided on Doppler USG follow-up, and various degrees of venous insufficiency were identified. A statistically significant improvement was observed in VCSS, CIVIQ-20, D-Dimer, VO, and VC measurements, although when the discrepancies between CIVIQ-20 and plethysmographic measurements were examined individually during the 6-month follow-up, nine (13.1%) patients were identified with comorbidities.</p><p><strong>Conclusions: </strong>Pharmacomechanical thrombolysis is an effective treatment approach for patients with acute DVT. Providing non-invasive objective data supporting the diagnosis and follow-up of venous diseases, the SGVOP approach offers significant benefits and should be considered more frequently as a viable therapy.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"1122-1132"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9451942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A prospective study on varicose veins surgery impact on systemic endothelial function evaluated by arterial brachial flow mediated dilation. 通过动脉肱动脉血流介导扩张评估静脉曲张手术对全身内皮功能影响的前瞻性研究。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-05-22 DOI: 10.1177/17085381231175707
Leandro Nóbrega, Rita Cardoso, Adelino Leite-Moreira, Ricardo Castro-Ferreira

Objectives: Chronic venous disease (CVD) is a prevalent pathology, and endothelial dysfunction is recognized as a core of its physiopathology. Flow-mediated dilation (FMD) is one of the most widely used tests for evaluating endothelial function. The aim of this study is to evaluate the influence of varicose vein (VV) surgery on FMD.

Methods: A prospective study with patients with superficial CVD and saphenous incompetence on Doppler ultrasonography that were proposed for VV surgery. The FMD test was performed before and 6 months after the procedure. The operator performing the post-operative evaluation was blinded to the pre-operative result.

Results: A total of 42 patients were included in the analysis. The median pre-operative percent change of FMD was 4.20% (±1.30) and the post-operative was 4.56% (±1.25) (p = 0.819).

Conclusions: Our findings do not corroborate the presence of an overall endothelial dysfunction prone to modulation by surgery. Nevertheless, further studies are needed to confirm our findings.

目的:慢性静脉疾病(CVD)是一种普遍存在的病理现象,而内皮功能障碍被认为是其生理病理的核心。血流介导的扩张(FMD)是评估内皮功能最广泛使用的测试之一。本研究旨在评估静脉曲张(VV)手术对 FMD 的影响:这项前瞻性研究的对象是拟接受静脉曲张手术的浅表心血管疾病和多普勒超声检查显示隐静脉瓣膜功能不全的患者。术前和术后 6 个月进行 FMD 测试。进行术后评估的操作者对术前结果是盲的:结果:共有 42 名患者参与了分析。术前 FMD 百分比变化中位数为 4.20% (±1.30),术后为 4.56% (±1.25)(P = 0.819):我们的研究结果并未证实存在易受手术调节的整体内皮功能障碍。尽管如此,还需要进一步研究来证实我们的发现。
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引用次数: 0
Increased Piezo1 expression in myofibroblasts in patients with symptomatic carotid atherosclerotic plaques undergoing carotid endarterectomy: A pilot study. 接受颈动脉内膜剥脱术的无症状颈动脉粥样硬化斑块患者肌成纤维细胞中 Piezo1 表达增加:一项试验性研究。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-07-27 DOI: 10.1177/17085381231192380
Takao Konishi, Kenji Kamiyama, Toshiaki Osato, Tetsuyuki Yoshimoto, Takeshi Aoki, Toshihisa Anzai, Shinya Tanaka

Objectives: We aimed to investigate Piezo1 expression in myofibroblasts in symptomatic and asymptomatic patients undergoing carotid endarterectomy and its relationship with atherosclerotic plaque formation.

Methods: This cross-sectional study analyzed carotid plaques of 17 randomly selected patients who underwent carotid endarterectomy from May 2015 to August 2017. In total, 51 sections (the most stenotic lesion, and the sections 5-mm proximal and distal) stained with hematoxylin-eosin and elastica-Masson were examined. Immunohistochemistry was performed using antibodies to Piezo1. The Piezo1 score of a section was calculated semiquantitatively, averaged across 30 randomly selected myofibroblasts in the fibrous cap of the plaque.

Results: Of 17 patients (mean age: 74.2 ± 7.1 years), 15 were men, 9 had diabetes mellitus, and 13 had hypertension. Symptomatic patients had higher mean Piezo1 score than asymptomatic patients (1.78 ± 0.23 vs 1.34 ± 0.17, p < .001). Univariate linear regression analyses suggested an association between plaque rupture, thin-cap fibroatheroma and microcalcifications and the Piezo1 score (p = .001, .008, and 0.003, respectively).

Conclusions: Increased Piezo1 expression of myofibroblasts may be associated with atherosclerotic carotid plaque instability. Further study is warranted to support this finding.

目的:我们旨在研究接受颈动脉内膜切除术的无症状和无症状患者肌成纤维细胞中Piezo1的表达及其与动脉粥样硬化斑块形成的关系:这项横断面研究分析了2015年5月至2017年8月期间随机选取的17名接受颈动脉内膜剥脱术患者的颈动脉斑块。共检查了51个切片(最狭窄病变以及近端和远端5毫米的切片),并用苏木精-伊红和弹性-马森染色。使用 Piezo1 抗体进行免疫组化。在斑块纤维帽中随机选取 30 个肌成纤维细胞,以半定量方式计算切片的 Piezo1 评分:在 17 名患者(平均年龄:74.2 ± 7.1 岁)中,15 人为男性,9 人患有糖尿病,13 人患有高血压。有症状患者的 Piezo1 平均得分高于无症状患者(1.78 ± 0.23 vs 1.34 ± 0.17,p < .001)。单变量线性回归分析表明,斑块破裂、薄盖纤维瘤和微钙化与 Piezo1 评分之间存在关联(p = .001、.008 和 0.003):结论:肌成纤维细胞 Piezo1 表达的增加可能与动脉粥样硬化性颈动脉斑块的不稳定性有关。需要进一步研究来支持这一发现。
{"title":"Increased Piezo1 expression in myofibroblasts in patients with symptomatic carotid atherosclerotic plaques undergoing carotid endarterectomy: A pilot study.","authors":"Takao Konishi, Kenji Kamiyama, Toshiaki Osato, Tetsuyuki Yoshimoto, Takeshi Aoki, Toshihisa Anzai, Shinya Tanaka","doi":"10.1177/17085381231192380","DOIUrl":"10.1177/17085381231192380","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to investigate Piezo1 expression in myofibroblasts in symptomatic and asymptomatic patients undergoing carotid endarterectomy and its relationship with atherosclerotic plaque formation.</p><p><strong>Methods: </strong>This cross-sectional study analyzed carotid plaques of 17 randomly selected patients who underwent carotid endarterectomy from May 2015 to August 2017. In total, 51 sections (the most stenotic lesion, and the sections 5-mm proximal and distal) stained with hematoxylin-eosin and elastica-Masson were examined. Immunohistochemistry was performed using antibodies to Piezo1. The Piezo1 score of a section was calculated semiquantitatively, averaged across 30 randomly selected myofibroblasts in the fibrous cap of the plaque.</p><p><strong>Results: </strong>Of 17 patients (mean age: 74.2 ± 7.1 years), 15 were men, 9 had diabetes mellitus, and 13 had hypertension. Symptomatic patients had higher mean Piezo1 score than asymptomatic patients (1.78 ± 0.23 vs 1.34 ± 0.17, <i>p</i> < .001). Univariate linear regression analyses suggested an association between plaque rupture, thin-cap fibroatheroma and microcalcifications and the Piezo1 score (<i>p</i> = .001, .008, and 0.003, respectively).</p><p><strong>Conclusions: </strong>Increased Piezo1 expression of myofibroblasts may be associated with atherosclerotic carotid plaque instability. Further study is warranted to support this finding.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"1063-1069"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular stenting techniques for blunt carotid injury. 治疗钝性颈动脉损伤的血管内支架技术。
IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-10-01 Epub Date: 2023-07-27 DOI: 10.1177/17085381231193062
Hossam Abdou, Rebecca N Treffalls, David P Stonko, Rishi Kundi, Jonathan J Morrison

Objectives: While methods of endovascular carotid artery stenting have improved over time, concerns surrounding the safety and efficacy of stenting for blunt carotid injury (BCI) remain. This study aims to present our approach to carotid artery stenting (CAS) by incorporating new technologies such as flow-diverting stents and circuits.

Methods: There is no robust evidence to support routine carotid artery stenting; however, there are several therapeutic options and approaches for treating BCI that currently require an individualized approach. Endovascular stenting and specific stent selection are largely dictated by the disease process the surgeon intends to treat. We will discuss patient selection, medical management, and the most common revascularization techniques, including transfemoral stenting, trans-carotid arterial revascularization using flow reversal, and stent-assisting coiling.

Results: It must be stressed that endovascular intervention is not an alternative to or preclusive of antithrombotic or anticoagulant therapy. In the setting of BCI, transfemoral CAS is most appropriate in patients who are symptomatic, have a rapidly progressing or large lesion, and do not have a soft thrombus present due to risk of embolism. Unlike transfemoral CAS, TCAR offers an elegant solution for embolic protection when patients have a soft thrombus present. In the case of a large pseudoaneurysm, we perform stent-assisted coiling.

Conclusions: We practice selective endovascular intervention, stenting lesions that are flow-limiting or have large or rapidly expanding pseudoaneurysms, and only in patients for whom anticoagulation and antiplatelet agents are not contraindicated. As technology and investigation progress, the concerns regarding the safety and the role of endovascular intervention in the treatment of BCI will be more clearly defined.

目的:随着时间的推移,血管内颈动脉支架植入术的方法不断改进,但围绕钝性颈动脉损伤(BCI)支架植入术的安全性和有效性的担忧依然存在。本研究旨在介绍我们采用分流支架和回路等新技术进行颈动脉支架植入术(CAS)的方法:方法:目前还没有强有力的证据支持常规颈动脉支架植入术;但是,目前有几种治疗 BCI 的治疗方案和方法,需要采取个体化的方法。血管内支架植入术和特定支架的选择在很大程度上取决于外科医生打算治疗的疾病过程。我们将讨论患者选择、医疗管理和最常见的血管重建技术,包括经股动脉支架植入术、使用血流逆转的经颈动脉血管重建术和支架辅助卷曲术:必须强调的是,血管内介入治疗不能替代或排除抗血栓或抗凝治疗。在 BCI 的情况下,经口 CAS 最适用于无症状、病变进展迅速或病变较大,且因存在栓塞风险而没有软血栓的患者。与经口 CAS 不同的是,当患者体内存在软血栓时,TCAR 为栓塞保护提供了优雅的解决方案。在假性动脉瘤较大的情况下,我们会进行支架辅助卷曲术:我们会选择性地进行血管内介入治疗,对血流受限或假性动脉瘤较大或迅速扩张的病变进行支架植入,而且只针对没有抗凝和抗血小板药物禁忌症的患者。随着技术和研究的进步,血管内介入治疗 BCI 的安全性和作用将得到更明确的界定。
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引用次数: 0
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