Vascular最新文献

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.

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.

IntroductionTo assess and compare the knowledge of ChatGPT and Google Gemini in answering public-based and scientific questions about peripheral artery disease (PAD).MethodsFrequently asked questions (FAQs) about PAD were generated by evaluating posts on social media, and the latest edition of the European Society of Cardiology (ESC) guideline was evaluated and recommendations about PAD were translated into questions. All questions were prepared in English and were asked to ChatGPT 4 and Google Gemini (formerly Google Bard) applications. The specialists assigned a Global Quality Score (GQS) for each response.ResultsFinally, 72 FAQs and 63 ESC guideline-based questions were identified. In total, 51 (70.8%) answers by ChatGPT for FAQs were categorized as GQS 5. Moreover, 44 (69.8%) ChatGPT answers to ESC guideline-based questions about PAD scored GQS 5. A total of 40 (55.6%) answers by Google Gemini for FAQs related with PAD obtained GQS 5. In addition, 50.8% (32 of 63) Google Gemini answers to ESC guideline-based questions were classified as GQS 5. Comparison of ChatGPT and Google Gemini with regards to GQS score revealed that both for FAQs about PAD, and ESC guideline-based scientific questions about PAD, ChatGPT gave more accurate and satisfactory answers (p = 0.031 and p = 0.026). In contrast, response time was significantly shorter for Google Gemini for both FAQs and scientific questions about PAD (p = 0.008 and p = 0.001).ConclusionOur findings revealed that both ChatGPT and Google Gemini had limited capacity to answer FAQs and scientific questions related with PDA, but accuracy and satisfactory rate of answers for both FAQs and scientific questions about PAD were significantly higher in favor of ChatGPT.

IntroductionSurgical site infections following arterial reconstructions with femoral exposures are common and potentially preventable. Negative pressure wound therapy has emerged as a potential solution to minimize groin wound complications. Our study evaluates efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions.MethodsA retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and June 2023. Patients were divided into two groups: patients treated with PICO device and patients who received standard dressing (non-PICO). Patient demographics, comorbidities, vascular evaluation, and procedure indications were compared. Previous interventions, incision orientation and procedure types were noted. The wound complication categories were graded according to the Szilagyi classification: grade 1 (superficial infection/minor dehiscence), grade 2 (deep infection/major dehiscence), and grade 3 (artery or prosthetic involvement). Statistical significance level was determined at p < .05 for all analyses.ResultsA total of 217 groin dissections in 184 patients were analyzed with 132 and 85 groin dissections in the PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups in terms of age, sex, BMI, and procedure indications. Prior endovascular procedures and re-operative groin surgeries were more prevalent in the PICO group. The use of antibiotics post-operatively for groin wound complication was greater in the non-PICO group. The incidence of wound complications was higher in the non-PICO group (29.4% vs 10.6%, p < .001). Multivariate logistic regression analysis determined that PICO dressing as well as hybrid and endovascular index procedures were associated with lower risks of groin complications.ConclusionPICO dressing decreased the incidence of groin wound complications in patients undergoing open vascular reconstructions. This study highlights the value of adjunctive negative pressure therapy in reduction of wound complications after arterial reconstructions in the inguinal region.

BackgroundsInfra-inguinal bypass (IIB) surgery is a time-proven and reliable management avenue for the treatment of peripheral arterial disease (PAD). The importance of ultrasound surveillance in maintaining IIB graft patency is well-recognised, yet adherence rates are underreported. This study evaluates the impact of surveillance compliance on graft outcomes in an Australian setting.MethodsA cross-sectional analysis of IIBs performed between 2010 and 2020 at a major vascular surgical institution in Australia was conducted retrospectively. Demographic data, peri-operative comorbidities and configuration of the bypass were captured as well as post-discharge results. Surveillance compliance was assessed based on adherence to post-operative ultrasound and clinic visits. The chief outcome measure was graft occlusion within 2 years. Secondary outcomes were major amputation, mortality and ambulatory function.ResultsOver a time period of 10 years, 239 bypasses were carried out on 207 individuals. 83% complied with surveillance protocols. Adherence rates were lower in regional patients. Non-compliance was significantly associated with vein graft occlusions (p < 0.01) but not with synthetic grafts. Regional referrals (p < 0.01), low pre-operative haemoglobin (p < 0.01), post-operative transfusion (p = 0.02) and use of prosthetic conduit (p < 0.01) were identified as significant predictors of graft thrombosis. Patients with occluded grafts were at substantially higher risk of ambulatory deterioration (2.4 fold), major limb amputation or death (8.6 fold) within 12 months. One-year survival without amputation was 88.3%.ConclusionEnhanced bypass graft surveillance is essential in clinical practice to minimise graft occlusion, reduction in morbidity, limb loss and death. This study reveals suboptimal compliance in Australian vascular surgical setting, particularly in regional areas, underscoring the need for improved education, resource allocation and infrastructural development.

BackgroundAbdominal aortic aneurysms (AAAs) are a significant vascular disease characterized by the degradation of medial elastic lamellae, neovascularization, and inflammatory responses. While surgical intervention remains the standard treatment for large or rapidly expanding AAAs, there is no universally accepted pharmacological therapy to prevent aneurysm progression. Matrix metalloproteinases (MMPs), particularly MMP-9, and inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) are implicated in AAA pathogenesis, making them potential therapeutic targets. Doxycycline, a broad-spectrum tetracycline antibiotic, has demonstrated inhibitory effects on MMP-9 and anti-inflammatory properties. However, its efficacy in slowing AAA progression remains unclear.MethodsA systematic review was conducted following PRISMA guidelines. Electronic searches were performed in PubMed, MEDLINE, EMBASE, and ClinicalTrials.gov. Inclusion criteria encompassed randomized controlled trials (RCTs), cohort studies, in vitro studies, and systematic reviews evaluating the effects of doxycycline on AAA growth. Data extraction was performed using Covidence software, and study quality was assessed using the Cochrane Risk of Bias Tool 2.0 (RoB2) for RCTs, the QUIN tool for in vitro studies, and the SYRCLE tool for animal experiments. Statistical analysis employed a random-effects model to evaluate heterogeneity among studies.ResultsThe initial search identified 1313 references, of which 10 studies met inclusion criteria: two RCTs, two systematic reviews, three in vitro studies, one in vivo study, one methodological study, and one experimental study. The two RCTs, involving 515 patients with an average age of 71 years, reported minimal to no significant reductions in AAA growth following doxycycline administration. In contrast, in vitro and in vivo studies demonstrated inhibition of MMP-9 and inflammatory markers, supporting doxycycline's potential therapeutic role. Meta-analysis was not performed due to high heterogeneity (I² = 75%). Risk of bias assessment indicated a low risk for RCTs, whereas in vitro and in vivo studies showed a moderate risk of bias.ConclusionWhile doxycycline exhibits promising biochemical effects in AAA pathophysiology, its clinical efficacy remains uncertain. Current evidence does not support its routine use in AAA management outside clinical trials. Future research should focus on targeted pharmacotherapy integrating patient-specific biomarkers to enhance therapeutic outcomes.

ObjectiveAlthough some publications are comparing the early clinical and anatomical results of endovenous laser ablation and endovenous cyanoacrylate embolization in great saphenous vein insufficiency, according to our knowledge, there are limited publications comparing the long-term clinical and anatomical results of these methods. I aimed to compare the long-term clinical and anatomical outcomes of these endovenous treatment methods.MethodsA total of 248 patients over the age of 18 who underwent endovenous laser ablation or endovenous cyanoacrylate embolization for the treatment of great saphenous vein insufficiency were included in the study. Patients who have been treated with a treatment method other than these methods were not included in this study. The equal numbers of patients were included in two groups according to the applied treatment methods. The groups were not fully matched in terms of baseline characteristics in this study, and significant differences were detected in age and preoperative reflux duration values (p < .05), and therefore, the results were re-analyzed with models (ANCOVA) adjusted for age and clinical severity parameters.ResultsEndovenous laser ablation or endovenous cyanoacrylate embolization procedures were performed in a total of 248 patients with a mean age of 51.22 ± 13.20 years. There was a statistically significant difference in mean age between the groups (p = .017). The mean preoperative CEAP score of study patients was 3.07 ± 0.57 (between 2 and 6), and the mean preoperative VCSS value was 6.85 ± 1.18. The average follow-up period of the study patients was 3.5 ± 0.50 years and at the end of the follow-up, a decrease in CEAP stage and VCSS values was observed in both groups.ConclusionsThe endovenous cyanoacrylate embolization offers similar long-term success rates to endovenous laser ablation, is a shorter procedure time, and offers advantages in returning to daily activities after the procedure. Both treatment methods, with effective and accessible healthcare systems, offer a variety of treatment options. The results of this study suggest that while both methods reduce the CEAP stage in the long term, endovenous cyanoacrylate embolization may provide a greater reduction. However, endovenous laser ablation may be more effective in reducing symptom severity (VCSS) and may offer an effective treatment option with lower complication rates and similar outpatient benefits and cost-effectiveness.

BackgroundThere is limited evidence supporting the optimal use of fistuloplasty to maintain vascular access at various lesion sites, despite its critical role in facilitating renal replacement therapy and the overall high failure rates of arteriovenous fistulas (AVFs). This study aims to identify covariates affecting primary and secondary patency following fistuloplasty of native upper limb vascular access AVFs.MethodsThis retrospective study included all patients who underwent fistuloplasty at a tertiary vascular centre over 4 years. Baseline characteristics were recorded, and factors associated with primary and secondary patency rates were analysed.ResultsA total of 206 patients (88 male, 118 female) with a mean age of 68 (±14) years underwent fistuloplasty during the study period. The prevalence of diabetes, ischaemic heart disease and antiplatelet usage were 33%, 21% and 70%, respectively. The median number of fistuloplasties per access during the follow-up period was 2 [1-3]. Fistulas were classified as radiocephalic (65), brachiocephalic (102) and brachiobasilic transposition (39). Recurrent stenosis (RS) was identified in 60 patients who had previous fistuloplasty before the study period, while 146 patients had de novo stenoses (DNS). Stenosis location significantly differed between RS and DNS (p = .03), with DNS primarily being anastomotic and RS predominantly in central and mixed locations. Younger fistulas were more likely to have anastomotic stenoses compared to those older than 1 year (p = .001). While no significant differences in primary patency (PP) were observed, secondary patency (SP) varied by stenosis location: Central 32 [13-42] months, Fistula vein 20 [12.5-35.5] months, Mixed 25 [13.5-37.5] months and Anastomotic 19 [7-29.5] months (p = .012).ConclusionStenosis location in AVFs is associated with the age and type of the fistula. Younger fistulas often fail due to anastomotic stenoses, which have lower secondary patency compared to stenoses at other sites. Preliminary data suggest that central stenoses, primarily occurring in older fistulas, exhibit better secondary patency following fistuloplasty than stenoses at other locations.