Vascular最新文献

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.

ObjectivesThe use of homograft for vascular reconstruction is a common practice in infective setting or to prevent aneurysmal dilation over the time. The use of fresh arterial homograft is conversely rarely reported.MethodsWe report a case about the use of fresh arterial homograft as a substitute of carotid intra-stent stenosis.ResultsWe describe the several steps of the procedure of a carotid stent graft explant and reconstruction with the interposition of the superficial femoral artery in a 29-year-old patient presenting with a carotid intra-stent stenosis. One-month postoperatively, the DUS showed the patency of the bypass graft.ConclusionsFresh in vivo superficial femoral artery for common carotid artery reconstruction may be considered in young patient as it provides excellent size-match, resistance to infection and low risk of aneurysmal degeneration.

ObjectiveTo compare the efficacy of compression stockings worn for 7 days or overnight after EVRFA.MethodsA single-centre, prospective, non-inferiority randomised controlled trial. The study included patients with clinical class C2-C4 chronic venous disease who underwent endovenous radiofrequency ablation (EVRFA) at Chulabhorn Hospital between October 2021 and October 2023. Sixty patients were assigned to wear the overnight compression group (n = 30) or for the 7-day compression group (n = 30). The primary outcome was targeted vein obliteration at 12 weeks. The secondary outcome measures were the revised Venous Clinical Severity Score (r-VCSS), Aberdeen Varicose Veins Severity Score (AVSS), pain score, complications and patient satisfaction.ResultsAt 12 weeks, both groups had a 100% target vein occlusion rate. There was no statistically significant difference in the r-VCSS, AVSS, patient satisfaction score, complications or pain score at day 1, day 14 and 12-16 weeks after the procedure. Overnight compression improved r-VCSS significantly.ConclusionOvernight compression was non-inferior to compression for 7 days after EVRFA.

ObjectivesPseudoaneurysm formation in connective tissue patients postoperatively can be a challenging and life-threatening problem to treat. Repair of an aorta to intercostal bypass graft pseudoaneurysm post open thoracoabdominal aortic aneurysm repair by percutaneous glue embolization utilizing Dyna CT Needle Guidance technology is a safe, minimally invasive method with low morbidity and short post-procedural recovery.MethodsA 30-year-old male with suspected connective tissue disorder who developed a Type B aortic dissection complicated by limb threatening right lower extremity ischemia treated with left-to-right fem-fem bypass and RLE fasciotomies. His thoracic aortic dissection subsequently was repaired urgently for persistent chest pain and rapid aortic expansion by open thoracoabdominal aortic aneurysm repair with aorta to intercostal bypass graft. Seven weeks postop patient presented with hemoptysis and was noted to have an enlarging T9 intercostal pseudoaneurysm requiring repair.Results and conclusionsPost discharge follow-up thoracic CTA performed showed complete resolution of the T9 intercostal pseudoaneurysm. Therefore, percutaneous NBCA glue embolization with iGuide technology is a viable alternative to open thoracic pseudoaneurysm repair and offers distinct advantages over other imaging modalities for localization.

PurposesAbdominal Aortic Aneurysm (AAA) screening via ultrasound in Caucasian males aged 65 and older has proven cost-effective in metropolitan areas. Evidence suggests that with adequate training, individuals without prior sonography experience can achieve accurate aortic measurements. This study evaluates the capability of junior doctors, after brief training, to conduct reliable AAA ultrasound screenings in a rural hospital setting, addressing the gap in speciality surgical services.MethodsThree junior doctors participated in a 2-hour practical ultrasound training, subsequently performing scans on both inpatients and community volunteers at a regional hospital. The analysis focused on measurement discrepancies within a 5 mm clinically acceptable difference, scanning efficiency, and aneurysm detection accuracy.ResultsA total of 71 participants were included. Among the screenings, 81.7% fell within the clinically acceptable discrepancy range, with 72.7% accuracy in inpatient scans and 95.5% in volunteer scans. Measurement reproducibility improved significantly with the standardisation of ultrasound techniques, and there was excellent agreement among operators in detecting aneurysms. Notably, scanning efficiency improved from the inpatient group to the volunteer group with statistical significance.ConclusionsJunior doctors demonstrated the ability to efficiently and reproducibly measure the infrarenal aortic diameter at a level comparable to experienced sonographers after only 2 hours of training. A single day of supervised practice is recommended to ensure standardised ultrasound technique. This approach offers a practical, cost-effective supplement to specialist radiology services in rural areas, enhancing access to critical screening procedures without proposing the replacement of professional sonographers.

ObjectiveThe evaluation of perioperative and long term outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) using anatomic (unibody) and proximal neck fixated (docking limbs) endografts across consecutive time cohorts.DesignThis study compares the outcomes of EVAR in Medicare patients stratified by mode of fixation.MethodsAll patients who underwent EVAR between 2012 and 2018 were identified in the Medicare database. Anatomic fixation (AF) and proximal fixation (PF) grafts were differentiated using Current Procedural Terminology (CPT) codes. The AF population was divided into three-time cohorts based on iterative changes in graft design: Cohort 1: (01/01/2012-20/07/2014); Cohort 2: (21/07/2014-09/05/2016); and Cohort 3: (10/05/2016-31/12/2017). The PF cohort was similarly divided into these three periods. Outcomes were evaluated through 31/12/2020 and included all-cause mortality, aortic rupture, and aortic-related reintervention.Results32,031 patients underwent EVAR during the study period; 4729 were AF and 27,302 were PF. There were more women (p < .001) and patients with peripheral vascular disease (PVD) (p < .001) in the AF group. There were no group differences in perioperative outcomes. In Cohort 1, there was a higher rate of reintervention (11.9% vs 7.6%; p < .001) and aortic rupture (5.3% vs 4.0%; p = .019) in the AF group compared to the PF group. In Cohort 2, reintervention, aortic rupture, and reintervention rates were similar between the two groups (p = NS). In Cohort 3, the reintervention and aortic rupture rates were similar between the two groups (p = NS).ConclusionThe higher rates of aortic rupture and reintervention seen in the AF group in Cohort 1 when compared with the PF group did not persist in Cohorts 2 and 3. This suggests that improvements in graft design may have led to durability which is similar to that of PF grafts. However, late aneurysm related complications are inherent risks after EVAR and long-term surveillance remains necessary.

BackgroundEndovascular procedures requiring large bore access, such as Transcatheter Aortic Valve Replacement (TAVR), Thoracic Endovascular Aortic Repair (TEVAR), and Endovascular Aneurysm Repair (EVAR), have become increasingly common. Despite advancements, complications from these procedures pose clinical challenges, especially in elderly and frail patients. The clinical objective of this paper is to demonstrate the complexities and innovative management strategies for complications that arise from large bore access.Case ReportThis report presents two cases illustrating percutaneous management of complications arising from large bore access during endovascular interventions. The first case involves a 74-year-old Asian female with a history of type A aortic dissection, who underwent TEVAR using a Gore TBE endograft. Post-procedure, the patient developed hemorrhagic shock due to disruption of the right external iliac artery. Interventions included upsizing the left femoral artery sheath, CODA balloon inflation in the distal aorta, and deployment of multiple VBX stents. The second case features a 24-year-old Caucasian female with a large pseudoaneurysm at the cannulation site in the aortic arch following a heart transplant. Successful TEVAR was performed to exclude the pseudoaneurysm. Closure of the right femoral artery access using 6 French ProGlide sutures was complicated, requiring balloon angioplasty to create an opening in the common femoral artery.ConclusionsThese cases highlight the challenges and innovative strategies in managing complications associated with large bore access during endovascular procedures. Insights gained from these experiences contribute to the armamentarium of interventionists, offering valuable guidance in addressing similar scenarios.

ObjectivesThe aim of this study was to assess the mid-term outcomes of the use of drug-coated balloons (DCBs) to treat infrainguinal peripheral arterial disease (PAD) in patients with dyslipidemia.MethodsBIOLUX P-III is a prospective, international, multicenter, all-comers registry-based study that was conducted at 44 sites with follow-ups at 6, 12 and 24 months. The present study is a subgroup analysis comparing the outcomes associated with endovascular revascularization with those associated with Passeo-18 lux DCBs in patients with and without dyslipidemia. The proportions of patients free from major adverse events (defined as device- or procedure-related mortality within 30 days, clinically driven target lesion revascularization (CD-TLR) and major target limb amputation), target vessel revascularization, and patient-reported outcomes within 24 months postintervention were compared between the two groups.ResultsA total of 876 patients with symptomatic PAD who underwent peripheral revascularization with DCBs and had information on their dyslipidemia status were included; 588 of those patients had dyslipidemia. There was no difference in the proportion of patients free from MAEs between the groups. The percentages of patients who were 6, 12 and 24 months free from CD-TLR were significantly lower in the dyslipidemia group than in the nondyslipidemia group (86.3% vs 91.9% at 2 years, p = .0183). Similarly, the percentage of patients free from target vessel revascularization was lower in the dyslipidemia group at all timepoints (83.3% vs 89.3% at 2 years, p = .0203). There was no difference in mortality or major or minor limb amputation rates. Other secondary outcomes were similar between the groups.ConclusionsCompared to those without dyslipidemia, patients with symptomatic PAD and dyslipidemia who underwent revascularization with a Passeo-18 lux DCB had greater rates of CD-TLR and TVR. However, having dyslipidemia did not increase the risk of mortality or limb amputation.Clinical Trial RegistrationNCT02276313.

BackgroundExtracranial internal carotid artery aneurysms are rare entities that arise within the carotid triangle. Although rare, they are clinically significant due to the risk of neurologic thromboembolic events, compression of cranial nerves and vasculature, rupture, and ischemia.ObjectiveSurgery is the gold-standard treatment for symptomatic patients of all ages with extracranial internal carotid artery aneurysm.MethodA 26-year-old female patient was admitted to our institution with complaints of left auricular pain, hoarseness, and uncontrollable hypertension. She had a pulsatile mass located at the left cervical region. After diagnosing the extracranial internal carotid artery aneurysm, it was decided that surgery was necessary to relieve the patient's discomfort and prevent possible complications from the aneurysm in the left carotid artery.ResultIn the operation, the aneurysmatic segment was resected and sent for histopathological evaluation. Saphenous vein graft was interposed as end to end anastomosis to the proximal and distal healthy segments of the internal carotid artery.ConclusionThis case report highlights the surgical management of a 26-year-old female patient who presented to our institution with complaints of left auricular pain, hoarseness, uncontrolled hypertension, and a pulsatile mass localized at the left cervical region and diagnosed extracranial internal carotid artery aneurysm.