Vascular最新文献

IntroductionPeripheral artery disease (PAD) poses a growing clinical challenge due to an aging population, despite advances in treatment methods. Various scoring systems have emerged to predict high-risk patients, including the HALP (hemoglobin, albumin, lymphocyte, and platelet) score, known for predicting prognosis in cancers and stroke. This study assesses the HALP score's relation to lesion severity and long-term mortality in PAD patients.MethodsWe retrospectively analyzed 305 symptomatic PAD patients undergoing endovascular intervention. The following formula was used to calculate the HALP score: hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L) / platelet count (/L). Lesion severity was classified by TASC-II: TASC AB and TASC CD. Mortality data were obtained from hospital and social security records.ResultsThe study involved 305 patients (mean age 64.4 ± 11.8 years; 72.1% male), divided into survivors (208) and non-survivors (97). ROC analysis identified HALP score as the strongest predictor of long-term mortality (AUC: 0.736; 95% CI: 0.679-0.793; p < .001). HALP score (HR, 0.087; 95% CI, 0.025-1.300; p < .001), age (p < .001), DM (p = .007), and CRP (p = .013) independently predicted mortality. Kaplan-Meier analysis showed higher HALP scores linked to lower long-term mortality (Log-rank: 20.102, p < .001), with an average follow-up of 48 ± 18 months.ConclusionThe HALP score emerged as a robust predictor of PAD prognosis, surpassing individual components and other parameters. Lower HALP scores correlated with more severe lesions and reduced life expectancy.

ObjectivesThis study aimed to investigate the feasibility of a commercially available tomographic freehand three-dimensional ultrasound (3D-US) system for surveillance of abdominal aortic aneurysms (AAAs) after endovascular repair (EVAR).MethodsIn 10 patients who underwent EVAR, a 3D-US scan was obtained post-operatively in addition to regular computed tomography angiography (CTA). Five independent observers evaluated 12 EVAR surveillance parameters for the 10 scans, resulting in a total of 600 individual observations.ResultsThe diameters of the neck, sac and iliac arteries were evaluable in most of the observations (neck: 80%, AAA sac: 98%, right CIA: 90%, left CIA: 68%). The diameter measurements of the 3D-US strongly correlated with the diameters measured on CTA (ρ = 0.90, p < .001). The general offset of 3D-US compared to CTA was -4.4 mm and the proportional bias was 3%. For all observers, the diameter measurements were significantly strongly correlated (O1:ρ = 0.85, O2:ρ = 0.88, O3:ρ = 0.93, O4:ρ = 0.96, O5:ρ = 0.86, p < .001 for all). The inter-observer reliability was excellent with an overall concordance correlation coefficient of 0.98. The start of the endograft, the lowest renal artery, the distance between these landmarks, and the proximal and distal sealing zones were evaluable in fewer than half of the observations (42%, 12%, 10%, 32%, 32%, 26%).Conclusion3D-US after EVAR is feasible. Diameters measured in 3D-US correlate strongly with CTA-based diameters and have a good interrater variability. However, the sealing zones are difficult to assess on 3D-US. This technique could be a useful addition to duplex ultrasound to facilitate offline 3D analysis, increase measurement reproducibility, enable volume measurements, and minimise the use of harmful CTA for surveillance after EVAR.

ObjectivePeripheral artery disease (PAD) is a chronic circulatory disorder characterized by atherosclerotic plaque buildup in the peripheral vascular system, restricting blood flow to the lower extremities and carrying a significant risk of morbidity and mortality. This study investigates the role of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic marker for assessing the severity of lower extremity peripheral artery disease (LEAD). The HALP score integrates hematologic and nutritional markers, providing a composite index that may reflect both the inflammatory and nutritional states impacting LEAD progression.MethodsA cross-sectional retrospective study was conducted, analyzing 186 patients diagnosed with LEAD through peripheral angiography. Participants were classified according to the TransAtlantic Inter-Society Consensus (TASC) II criteria, with mild to moderate disease (TASC A-B) and severe disease (TASC C-D). Laboratory data were collected within the first week of diagnosis, and HALP scores were calculated. The association between HALP scores and LEAD severity was evaluated through correlation and logistic regression analyses. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were also analyzed.ResultsSignificant differences were observed between TASC A-B and TASC C-D groups in demographic and clinical variables. Patients in the severe LEAD group were older, had a higher prevalence of diabetes and hyperlipidemia, and exhibited lower hemoglobin and albumin levels with higher platelet counts (p < .001). A significant inverse correlation was found between HALP score and LEAD severity (R = -0.607, p < .001), indicating that lower HALP scores are associated with more advanced disease. The HALP score displayed strong discriminatory performance in ROC analysis (AUC = 0.889), with an optimal cut-off of 3.14 providing 81% sensitivity and 80% specificity for predicting severe LEAD.ConclusionThe HALP score is a valuable, non-invasive predictor of LEAD severity and may serve as a practical tool for clinical risk assessment. Incorporating the HALP score into routine evaluation protocols could support more personalized management approaches for patients with LEAD, guiding both therapeutic decisions and long-term monitoring.

BackgroundIt is still challenging to perform high-risk cases, such as acute type A dissection, which frequently require blood transfusions. We created perioperative bloodless protocol, but it includes an optimization to increase the preoperative hemoglobin level enough to tolerate cardiopulmonary bypass. However, it would be impossible to optimize such patients using the strategy in the setting of emergent surgery. We sought to create a surgical strategy in an effort to reduce blood loss for acute type A dissection patients refusing blood transfusion.MethodsWe reviewed the records of two patients in our aortic surgery database who presented with acute aortic dissection and refused blood transfusion. These patients underwent two-staged aortic repair with ascending aortic replacement with debranching to the innominate and left common carotid arteries, followed by thoracic endovascular aortic repair (TEVAR).Results: The two-staged procedure was successfully completed in two patients without any significant complication. The postoperative course was uneventful for both patients.ConclusionTwo-staged aortic repair in patients refusing blood transfusion can avoid circulatory arrest requiring deep hypothermia so as to reduce the risk of coagulopathy and blood loss.

ObjectivesTo evaluate the efficacy of different methods of interfacial elastic compression and their association with obesity and chronic venous insufficiency (CVI).MethodsForty legs with vascular disease and 40 control legs were analyzed. Four different methods of elastic compression were applied and interface pressure was measured. Blood flow volume and peak systolic velocity (SPV) were measured before and during compression.ResultsAlthough there are no general differences correlating higher interface pressures with higher blood flow volume and SPV in CVI patients and controls, there are specific differences related to obesity. Obese participants had lower CVI and higher blood flow volume, in whom higher interface pressure promoted better results.ConclusionsThere is no standard method of compression for all patients. Variables such as the presence of CVI, body mass index, and gender must be taken into account in order to achieve a better individual method of compression therapy.

BackgroundEndovascular therapy with balloon percutaneous angioplasty (PTA) in the femoro-popliteal segment is frequently performed, however, long-term favorable outcomes and patency remain challenging, with restenosis rates reaching 60% post-standard balloon angioplasty. Drug-coated balloons (DCBs) have shown promise in improving these outcomes; Paclitaxel, used in DCBs, inhibits hyperplasia and smooth muscle cell proliferation, reducing restenosis; however, the optimal dose of Paclitaxel remains unclear, with high-dose (HD-DCB [>3 mg/mm²]) and low-dose (LD-DCB [<2.0 mg/mm²]) options available. This meta-analysis aims to compare the efficacy and safety of HD-DCB and LD-DCB in treating femoropopliteal arterial disease.MethodsWe followed PRISMA guidelines and conducted a comprehensive search of PubMed, EMBASE, Cochrane, Scopus, and Mendeley up to May 27, 2024. We included randomized controlled trials and cohort studies comparing HD-DCB and LD-DCB in patients with femoropopliteal arterial disease. Data were extracted on baseline characteristics, outcomes, and study quality. The Newcastle-Ottawa Scale and ROB2 tool were used for bias assessment. Outcomes included overall survival (OS), limb salvage (LS), freedom from clinically driven target lesion revascularization (CD-TLR), and major amputation.ResultsSix studies comprising 2563 patients were included. HD-DCB showed a significant benefit in limb salvage at 6 months (RR = 0.38, 95% CI = 0.18-0.78, p = .009) but not at 12 months (RR = 3.08, 95% CI = 0.14-67.13, p = .47). No significant difference was observed in overall survival between HD-DCB and LD-DCB at either 6 months (RR = 1.53, 95% CI = 0.25-9.57, p = .65) or 12 months (RR = 1.21, 95% CI = 0.17-8.84, p = .85). HD-DCB was associated with an increased risk of perioperative complications (RR = 1.90, 95% CI = 1.14-3.17, p = .01) and a higher, though not statistically significant, risk of major amputation (RR = 4.73, 95% CI = 0.54-41.52, p = .16).ConclusionHD-DCB may offer advantages in limb salvage over LD-DCB in the short term, but this comes with an increased risk of perioperative complications. These findings underscore the need for careful patient selection when considering HD-DCB for femoropopliteal artery disease.

ObjectiveSuperior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction.MethodsThis was a single-center, retrospective study that included all patients who underwent SVC reconstruction using femoral vein from January 2000 to December 2023. Follow-up period analysis included reconstruction patency, surgical reinterventions, patient's symptoms, and complications.ResultsTen patients underwent central venous reconstruction or bypass using the femoral vein, with an average age of 51.88 years ± 10.20 years. SVC syndrome was primarily caused by benign etiologies including pacemakers and indwelling central venous catheters. Common presenting symptoms included head or neck fullness and upper extremity edema. The median follow-up duration was 21 months. Primary patency at 1 year was 79%.ConclusionFemoral vein reconstruction presents a promising solution for managing SVC obstruction, offering effective symptom relief and acceptable venous patency rates. Further research including prospective trials and comparative studies is crucial to refining surgical techniques and understanding long-term efficacy in addressing this complex clinical issue.

ObjectivesProximal to mid-term effects of contrast excimer laser atherectomy (ELA) + drug-coated balloon (DCB) versus PTA + drug-coated balloon (DCB) in the treatment of new lesions in the femoral popliteal segment of patients with lower extremity arteriosclerosis and occlusion.MethodsThe clinical data of 105 patients with CT-confirmed femoropopliteal segment lesions (Rutherford grades 3-6) were retrospectively analyzed. According to the computerized randomization method, 58 patients (44 males, mean 72.41 ± 10.58 years) were divided into group A ELA + DCB dilation and 47 patients (35 males, mean 73.83 ± 11.56 years) in group B PTA + DCB dilation. The clinical indexes mainly included the occurrence of Rutherford grade, freedom from target lesion revascularization rate (FTLR), ankle-brachial index (ABI), stage I survival rate, and postoperative complications before, 6 months, and 12 months after surgery and were compared between the two groups.ResultsThe treatment success rate was 100% in all patients. The Rutherford grading at 12 months after operation was significantly improved in both groups, but statistical analysis showed that the improvement was more significant in group A (87.93% vs 72.34%, p = 0.043); ABI (0.77 ± 0.22^abc vs 0.65 ± 0.10^abc, p = 0.001); FTLR (93.10% vs 78.72%, p = 0.031), respectively. First-stage patency rate (91.38% vs 74.47%, p < 0.001),; complications, and adverse events were not statistically significant between the two groups (p > 0.05).ConclusionsELA + DCB significantly improved the 1-year freedom from target lesion revascularization rate and stage 1 patency rate with no significant increase in complications or adverse events.

BackgroundEndovascular intervention by means of thrombolysis is emerging as a promising management of Acute Aortic Occlusion (AAO). This study aims to evaluate the outcomes of endovascular thrombectomy for AAO cases in a single-center tertiary hospital in Indonesia.MethodsWe review retrospectively AAO patients treated by Rheolytic thrombectomy ± stenting or TEVAR at our referral center from 2011 to 2024. Clinical characteristics and outcomes were analyzed independently and in correlation to one another.ResultOut of 21 episodes in 19 patients, AAO was correlated with thromboembolism in 57.1 %, in situ thrombosis in 23.8%, and malperfusion syndrome in 19% of patients. Most prevalent comorbidities found were coronary arterial disease, hypertension, heart failure, and atrial fibrillation. Method of revascularization were Rheolytic thrombectomy (12), covered stent (5), catheter-directed thrombolysis (2), and TEVAR (4) with an average 90.9% success rate. In-hospital mortality was 21% and did not vary significantly according to etiology (thromboembolism 30% vs in situ thrombosis 20%) except for malperfusion syndrome 0% which comprised of four patients. All fatality occurred among patients with history of coronary artery disease and one failed revascularization case required urgent amputation (5.3%). Average length of stay was 8.67 ± 5.31 days.ConclusionBased on our data, thromboembolism remained highly associated with occurrence of AAO. Endovascular approach by Rheolytic thrombectomy is proven to be comparable or slightly superior in restoring occluded aorto-iliac connection compared to conventional management options. Compared to previous studies, this study establishes a wider representation of AAO cases treated by endovascular means considering the rarity of cases.