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Haemorrhagic Safety Update of CLEAR-PATH: 30 Day and 12 Month Antiplatelet Therapy After Peripheral Angioplasty CLEAR-PATH的出血安全性更新:周围血管成形术后30天和12个月的抗血小板治疗
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2026-01-01 DOI: 10.1016/j.ejvsvf.2025.11.005
Emilien C.J. Wegerif , Manon I. Generaal , Linde J. Vijn , Rutger M. van den Bor , Peter M. van de Ven , Michiel L. Bots , Gert J. de Borst , Çağdaş Ünlü

Objective

Antiplatelet therapy (APT) bleeding risks after endovascular revascularisation (EVR) in peripheral arterial disease (PAD) patients are lacking. Therefore, this Dutch, multicentre, double blind, placebo controlled randomised trial aimed to determine the haemorrhagic safety of APT within 30 days and 12 months after EVR by using data from the ongoing CLEAR-PATH trial.

Methods

Symptomatic PAD patients after successful EVR were randomised to clopidogrel plus placebo or acetylsalicylic acid for 12 months. The primary endpoint was major bleeding (MB) following the TIMI (Thrombolysis in Myocardial Infarction) classification within 12 months. Secondary endpoints included MB within 12 months following ISTH (International Society on Thrombosis and Haemostasis) and BARC (Bleeding Academic Research Consortium) classification, within 30 days following all classifications, and any bleeding. Analyses were blinded for treatment since the CLEAR-PATH is ongoing. It was agreed that APT groups had MB events above 0.0% and that a difference of 3.0% within 12 months was acceptable.

Results

Between August 2022 and January 2024, 470 patients were randomised. Of these, 103 patients were eligible for 12 month analysis, and 440 patients for 30 month analysis. Patients presented with chronic limb threatening ischaemia (32%) or intermittent claudication (68%). MB incidences within 12 months following TIMI, ISTH, and BARC classifications were 1.9% (95% confidence interval 0.5–6.8), 1.0%, and 2.9%, respectively. The maximum difference between APT groups was 2.8%. MB incidences within 30 days following the TIMI, BARC, and ISTH were 0.9%, 0.7%, and 1.4%, respectively. Six of seven events occurred within 30 days, three of seven events were related to vascular procedures, and one event led to cardiovascular death.

Conclusion

CLEAR-PATH is building a unique, large, well phenotyped PAD cohort. The incidence of MB under APT after EVR differed per classification but was overall low; most occurred within the first 30 days and were related to vascular procedures. The APT regimens raised no haemorrhagic safety concerns; therefore, CLEAR-PATH continues per protocol.

Trial registration

NL80009.041.21, www.clinicaltrialsregister.eu.
目的:外周动脉疾病(PAD)患者血管内血管重建术(EVR)后抗血小板治疗(APT)出血风险尚缺乏。因此,这项荷兰、多中心、双盲、安慰剂对照的随机试验旨在通过使用正在进行的CLEAR-PATH试验的数据,确定EVR后30天和12个月内APT的出血安全性。方法将EVR成功后有症状的PAD患者随机分为氯吡格雷加安慰剂组或乙酰水杨酸组,为期12个月。主要终点是12个月内TIMI(心肌梗死溶栓)分类后的大出血(MB)。次要终点包括ISTH(国际血栓和止血学会)和BARC(出血学术研究联盟)分类后12个月内的MB,所有分类后30天内的MB,以及任何出血。由于CLEAR-PATH正在进行中,因此对治疗进行了盲法分析。一致认为APT组的MB事件高于0.0%,12个月内的差异为3.0%是可以接受的。结果在2022年8月至2024年1月期间,470名患者被随机分组。其中,103例患者符合12个月的分析,440例患者符合30个月的分析。患者表现为慢性肢体威胁性缺血(32%)或间歇性跛行(68%)。TIMI、ISTH和BARC分类后的12个月内MB发病率分别为1.9%(95%可信区间0.5-6.8)、1.0%和2.9%。APT组间最大差异为2.8%。TIMI、BARC和ISTH术后30天内MB发病率分别为0.9%、0.7%和1.4%。7个事件中的6个发生在30天内,7个事件中的3个与血管手术有关,1个事件导致心血管死亡。clear - path正在建立一个独特的、大型的、表型良好的PAD队列。EVR术后APT下MB的发生率各分类不同,但总体较低;大多数发生在前30天内,与血管手术有关。APT方案没有引起出血安全问题;因此,每个协议都继续执行CLEAR-PATH。试验注册号nl80009.041.21, www.clinicaltrialsregister.eu。
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引用次数: 0
Endovascular Management of Renal Arteriovenous Fistula Associated with Nutcracker Syndrome 胡桃夹子综合征相关肾动静脉瘘的血管内治疗
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2026-01-01 DOI: 10.1016/j.ejvsvf.2025.11.006
Olivier Creton , Anne Taquet , Fabien Boulière

Introduction

Renal arteriovenous fistulae (AVFs) and Nutcracker syndrome (NCS) are rare vascular anomalies. This report describes the case of a renal AVF associated with NCS presenting as pelvic congestion syndrome (PCS).

Case Report

A 62 year old woman presented with chronic pelvic pain and exertional dyspnoea. Imaging revealed a large left renal AVF draining into the left ovarian vein, associated with NCS. The patient underwent two stage endovascular treatment: embolisation of the left renal artery using Amplatzer Vascular Plugs (Abbott; Abbott Park, IL, USA), followed nine months later by embolisation of pelvic varices using glue. Symptoms resolved completely and were sustained at the four year follow up.

Discussion

The co-existence of renal AVFs and NCS may exacerbate venous hypertension and aggravate PCS symptoms. Endovascular embolisation offers a safe, minimally invasive, and effective therapeutic option in anatomically complex cases, avoiding the morbidity of open surgery. This case highlights the need to consider vascular anomalies such as AVFs and NCS in women with PCS. Staged endovascular embolisation can provide excellent outcomes in select patients.
肾动静脉瘘(AVFs)和胡桃夹子综合征(NCS)是一种罕见的血管异常。本报告描述肾脏AVF合并NCS表现为盆腔充血综合征(PCS)的病例。病例报告:一名62岁女性,以慢性盆腔疼痛和用力性呼吸困难为主诉。影像显示一个大的左肾AVF引流到左卵巢静脉,与NCS相关。患者接受了两个阶段的血管内治疗:使用Amplatzer血管塞(Abbott; Abbott Park, IL, USA)栓塞左肾动脉,9个月后使用胶水栓塞盆腔静脉曲张。在四年的随访中,症状完全消失并持续。肾脏avf与NCS共存可加重静脉高压,加重PCS症状。血管内栓塞为解剖结构复杂的病例提供了一种安全、微创、有效的治疗选择,避免了开放手术的发病率。本病例强调了在女性PCS患者中需要考虑血管异常,如avf和NCS。分阶段血管内栓塞可以为特定的患者提供良好的结果。
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引用次数: 0
Retroperitoneal Abdominal Aortic Repair With the da Vinci Single Port System: A Porcine Model Feasibility Study 用达芬奇单端口系统修复腹膜后腹主动脉:猪模型可行性研究
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2026-01-01 DOI: 10.1016/j.ejvsvf.2025.11.007
Toshio Takayama , Hubert Stein , Hideaki Obara , Toshifumi Kudo , Mark Preuß , Rouven Berndt , Sebastian Eike Debus , Takayuki Komiya , Hiroyuki Kaneta , Fabien Thaveau

Objective

Robotic surgery is rarely used in vascular surgery but has demonstrated significant potential compared with open or laparoscopic techniques in reports of abdominal aortic surgery. Enabling a standardised retroperitoneal approach (RPA) to abdominal aortic repair might reduce the peri-operative mortality and morbidity rates associated with a transabdominal approach. The aim of this experimental study was to establish surgical techniques for robotically assisted infrarenal abdominal aortic repair using a single port RPA.

Methods

Retroperitoneal abdominal aortic repair was performed in four live porcine models by a group of experienced and novice robotic surgeons. The procedures were performed using the da Vinci SP (single port) surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Polytetrafluoroethylene grafts (W.L. Gore & Associates, Inc., Newark, DE, USA) were implanted after aortic resection. Operating times for the main procedure steps were recorded.

Results

Abdominal aortic repair was feasible in all porcine models applying an RPA through a single incision with the da Vinci SP system. Creating the retroperitoneal access and docking the da Vinci SP was quick, with durations ranging from eight to 20 minutes. Proximal and distal anastomoses were completed in 26 minutes (range 19–33 minutes) and 31.3 minutes (range 23–42 minutes), respectively. In porcine models 2–4, the anastomoses were patent without haemorrhage, with aortic pulsations confirmed on release of the cross clamps. Porcine model 1 was pulseless owing to uncontrolled haemorrhage caused by left external iliac artery penetration at the end of the procedure, and patency could not be tested.

Conclusion

Retroperitoneal single port robotic aortic repair was technically feasible with high accuracy in live porcine models. Anastomotic times were reasonable and surgeon comfort level was adequate, which may enable transfer into clinical routine in the future when true clinical benefits will need to be proven in additional studies.
目的机器人手术很少用于血管手术,但在腹主动脉手术的报道中,与开放或腹腔镜技术相比,机器人手术显示出巨大的潜力。采用标准化的腹膜后入路(RPA)进行腹主动脉修复可能会降低与经腹入路相关的围手术期死亡率和发病率。本实验研究的目的是建立机器人辅助肾下腹主动脉修复的手术技术,使用单端口RPA。方法分别由一组经验丰富的机器人和一组新手对4只活体猪进行腹膜后腹主动脉修复。手术采用达芬奇SP(单端口)手术系统(Intuitive surgical Inc., Sunnyvale, CA, USA)。在主动脉切除术后植入聚四氟乙烯移植物(W.L. Gore & Associates, Inc., Newark, DE, USA)。记录了主要程序步骤的操作时间。结果采用da Vinci SP系统经单切口RPA修复所有猪腹主动脉模型均可行。建立腹膜后通道和对接达芬奇SP非常迅速,持续时间从8到20分钟不等。近端吻合和远端吻合分别在26分钟(范围19-33分钟)和31.3分钟(范围23-42分钟)完成。在猪模型2-4中,吻合口通畅,无出血,在释放十字夹时证实主动脉搏动。1号模型猪无脉,由于手术结束时左髂外动脉穿透导致出血失控,无法检测通畅程度。结论腹膜后单孔机器人主动脉修复术在技术上是可行的,准确度高。吻合时间合理,外科医生的舒适度足够,当真正的临床益处需要在进一步的研究中得到证实时,这可能会在未来转移到临床常规。
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引用次数: 0
Delayed Diagnosis of a Traumatic Popliteal Arteriovenous Fistula After 54 Years: Case Report, Surgical Management, and Literature Review 外伤性腘动静脉瘘54年后的延迟诊断:病例报告、手术处理和文献回顾
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2026-01-01 DOI: 10.1016/j.ejvsvf.2025.11.004
Corrado Cirielli , Federica Orlando , Francesco Snider , Pietro Modugno

Objective

Traumatic popliteal arteriovenous fistulas are rare vascular disorders, usually resulting from penetrating injuries. Most cases become symptomatic within a few months; however, exceptionally long latency periods have been reported, usually spanning two to three decades. This report describes a case of a traumatic popliteal arteriovenous fistula caused by penetrating trauma to the popliteal region during childhood with an extraordinary latency of 54 years before the onset of symptoms. Diagnostic and therapeutic approaches and a literature review are discussed in the context of this rare presentation.

Methods

A 61 year old woman presented to the hospital’s outpatient clinic with progressive pain, venous hypertension in the left lower limb, and exertional dyspnoea, which had become evident over the past 6 months. Physical examination revealed left leg oedema with significant lymphovenous stasis, diminished tibial pulses, and a palpable pulsatile mass in the popliteal fossa, accompanied by a systolic bruit—findings suggestive of an arteriovenous fistula. Initially, the patient did not recall any recent trauma or associate her symptoms with a past injury. However, a detailed medical history revealed a penetrating injury to the popliteal region sustained at the age of 7 years. Doppler ultrasound and computed tomography angiography confirmed a high flow popliteal arteriovenous fistula with venous dilation.

Results

Following a thorough evaluation, surgical repair was preferred over endovascular intervention due to the complex anatomical characteristics and location of the fistula. After surgery, the patient experienced complete resolution of symptoms.

Conclusions

This case demonstrates that traumatic popliteal arteriovenous fistulas can have an exceptionally prolonged latency period, emphasising the need for clinical vigilance and comprehensive diagnostic imaging, even in patients with a remote history of trauma. Although endovascular treatments are increasingly favoured, open surgical repair remains a crucial and effective option for particularly complex post-traumatic popliteal arteriovenous fistulas.
目的外伤性腘动静脉瘘是一种罕见的血管疾病,通常由穿透性损伤引起。大多数病例在几个月内出现症状;然而,异常长的潜伏期也有报道,通常跨越二至三十年。本文报告一例儿童时期腘窝区域穿透性创伤引起的外伤性腘窝动静脉瘘,在出现症状之前潜伏期为54年。诊断和治疗的方法和文献回顾讨论在这种罕见的情况下提出。方法一名61岁女性患者以进行性疼痛、左下肢静脉高压、用力性呼吸困难就诊于我院门诊,6个月来表现明显。体格检查显示左腿水肿伴明显淋巴静脉淤积,胫骨脉搏减弱,腘窝可触及搏动性肿块,伴有收缩期杂音,提示动静脉瘘。最初,患者不记得任何最近的创伤或将其症状与过去的损伤联系起来。然而,详细的病史显示7岁时腘窝区域有穿透性损伤。多普勒超声和计算机断层血管造影证实一个高流量腘动静脉瘘伴静脉扩张。结果经过全面评估后,由于瘘管的复杂解剖特征和位置,手术修复优于血管内介入治疗。手术后,患者症状完全缓解。结论:本病例表明外伤性腘动静脉瘘可有异常延长的潜伏期,强调临床警惕和综合诊断成像的必要性,即使是有较远创伤史的患者。尽管血管内治疗越来越受青睐,但对于特别复杂的创伤后腘动脉动静脉瘘,开放手术修复仍然是一个关键和有效的选择。
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引用次数: 0
Chronic Q Fever Presenting as a Contained Rupture of an Infected Native Aortic Aneurysm: A Case Report 慢性Q热表现为感染的原生主动脉瘤的包含性破裂:1例报告
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2026-01-01 DOI: 10.1016/j.ejvsvf.2025.11.003
Lea Schacher , Laina Passos , Michel Bosiers , Vladimir Makaloski , Daniel Becker , Drosos Kotelis

Introduction

Coxiella burnetti (C. burnetii) is the causative agent of Q fever. Chronic Q fever may lead to various complications, including infected native aortic aneurysms (INAA). Both INAA and chronic Q fever typically present with non-specific symptoms, often resulting in delayed diagnosis. While current guidelines provide recommendations for the management of INAA, there are no specific or standardised protocols addressing INAA in the context of chronic C. burnetii infection. However, antimicrobial therapy should be directed towards the causative pathogen. This case report describes a rare case of INAA secondary to chronic Q fever.

Case

A 64 year old man presented with lumbar pain due to contained rupture of a juxtarenal abdominal aortic aneurysm. Urgent open surgical repair with inter-renal clamping, resection of infected tissue, reconstruction with pericardial tube graft and omental flap plasty was performed due to suspicion of infection. Intra-operative samples revealed C. burnetii to be the causative agent of chronic Q fever. Oral antibiotic treatment with doxycycline 100 mg twice daily and hydroxychloroquine 200 mg thrice daily was established.

Discussion

C. burnetii infection should be considered as a possible pathogen in a case of culture negative INAA. Early diagnosis, open surgical treatment using bovine material and omental flap plasty, prolonged targeted antimicrobial therapy, and follow up assessment with blood samples and computed tomography scans in close cooperation with infectious disease specialists are recommended to improve outcomes in these rare and challenging cases. Case reports such as this contribute to raising clinical awareness and provide valuable insights into the absence of standardised treatment guidelines.
伯纳蒂克希菌(C. burnetii)是Q热的病原体。慢性Q热可导致各种并发症,包括感染原生主动脉瘤(INAA)。INAA和慢性Q热通常都有非特异性症状,常常导致诊断延迟。虽然目前的指南为INAA的管理提供了建议,但在慢性伯氏杆菌感染的背景下,没有针对INAA的具体或标准化方案。然而,抗菌治疗应直接针对致病病原体。本病例报告描述了一例罕见的慢性Q热继发INAA病例。病例一:64岁男性,因腹主动脉瘤破裂致腰痛。由于怀疑感染,我们进行了肾间夹持、切除感染组织、心包管移植重建和大网膜瓣成形术的紧急开放手术。术中样本显示伯氏杆菌是慢性Q热的病原体。采用强力霉素100 mg,每日2次,羟氯喹200 mg,每日3次口服抗生素治疗。在培养阴性的INAA病例中,应考虑伯纳蒂感染为可能的病原体。建议早期诊断,使用牛材料和大网膜瓣成形术进行开放手术治疗,延长靶向抗菌治疗,并与传染病专家密切合作,通过血液样本和计算机断层扫描进行随访评估,以改善这些罕见和具有挑战性的病例的预后。诸如此类的病例报告有助于提高临床认识,并为缺乏标准化治疗指南提供有价值的见解。
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引用次数: 0
Clinician Attitudes towards Analgesia for Chronic Limb Threatening Ischaemia: A Survey of Vascular Specialists to Inform a Topical Morphine Trial. 临床医生对慢性肢体威胁性缺血镇痛的态度:一项血管专家的调查,以告知局部吗啡试验。
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-12-31 eCollection Date: 2026-01-01 DOI: 10.1016/j.ejvsvf.2025.12.001
Henry Davies, Marie-José Vleugels, Mimmie Kwong, Anahita Dua, Nasim Akhtar, Barend M E Mees, Sarah Mitchell, David Russell

Objective: Current analgesic strategies often treat pain associated with chronic limb threatening ischaemia (CLTI) inadequately and frequently result in significant side effects. This cross sectional, web based, vascular specialist survey study aimed to explore clinician perspectives on current pain management and the potential role of topical morphine to inform future research in this area.

Methods: A cross sectional online survey was distributed to vascular surgeons, physicians, and allied health professionals involved in the care of patients with CLTI. The 16 question survey included both closed and open ended items exploring perceptions of current analgesia adequacy, experience with topical morphine (e.g., morphine in gel preparations), and attitudes toward future clinical research. The questionnaire was disseminated via national and international vascular societies, professional mailing lists, and social media platforms. Responses were recorded anonymously and stratified using five point Likert scales (strongly disagree to strongly agree).

Results: Of the 104 respondents, most were consultant vascular surgeons (57%) or speciality registrars (14%), with the majority based in the UK (89%). Pain control for CLTI was rated as suboptimal by 96% of respondents in outpatient settings and 78% in inpatient settings. No respondents strongly agreed that pain was adequately managed in either context. Only eight respondents reported experience using topical morphine; of these, three reported it as effective most of the time and five said it was effective sometimes. Nonetheless, 79% expressed willingness to randomise patients with ulcers to a trial of topical morphine, and 85% were willing to include patients without ulcers. All but one of the 104 respondents agreed that reducing systemic analgesia would be of significant patient benefit.

Conclusion: There is both a clinical need and strong support among vascular clinicians for research into optimised analgesic regimens for CLTI. Despite limited current experience with topical morphine, the majority are willing to recruit to a trial.

目的:目前的镇痛策略往往不能充分治疗慢性肢体威胁性缺血(CLTI)相关的疼痛,并且经常导致明显的副作用。这项横断面、基于网络的血管专家调查研究旨在探讨临床医生对当前疼痛管理的看法,以及局部吗啡的潜在作用,为该领域的未来研究提供信息。方法:对参与CLTI患者护理的血管外科医生、内科医生和专职卫生专业人员进行横断面在线调查。16个问题的调查包括封闭式和开放式问题,探讨当前镇痛充分性的看法,局部吗啡的使用经验(例如,凝胶制剂中的吗啡),以及对未来临床研究的态度。调查问卷通过国家和国际血管学会、专业邮件列表和社交媒体平台分发。回答是匿名记录的,并使用五点李克特量表(强烈不同意到强烈同意)分层。结果:在104名受访者中,大多数是咨询血管外科医生(57%)或专业注册医师(14%),其中大多数在英国(89%)。96%的门诊患者和78%的住院患者认为CLTI的疼痛控制是次优的。在这两种情况下,没有受访者强烈同意疼痛得到了充分的控制。只有8名受访者报告使用过局部吗啡;其中,3人表示大多数时候有效,5人表示有时有效。尽管如此,79%的人表示愿意将溃疡患者随机分配到局部吗啡试验中,85%的人愿意将没有溃疡的患者纳入试验。104名应答者中除一人外,所有人都同意减少全身镇痛对患者有显著益处。结论:研究CLTI的最佳镇痛方案既有临床需要,也得到了血管临床医生的大力支持。尽管目前使用局部吗啡的经验有限,但大多数人都愿意接受试验。
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引用次数: 0
Validation of a Deep Learning U-Net Algorithm for Multistructure Segmentation of Infrarenal Abdominal Aortic Aneurysms including Lumen, Thrombus, and Calcifications 一种深度学习U-Net算法在包括管腔、血栓和钙化的肾下腹主动脉瘤多结构分割中的验证
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-11-13 DOI: 10.1016/j.ejvsvf.2025.11.001
Lucie Derycke , Asmaa Doudouh , Florian Cotte , Abdelmalek Habi , Jean-Noel Albertini , Antoine Millon

Objective

Artificial intelligence and digital twin technologies provide a new way to plan endovascular interventions and can help practitioners anticipate complications. The accuracy of these methods is based on reliable automated aortic segmentation, including intraluminal thrombus (ILT), calcifications, and detection of collateral arteries. The aim of this study was to validate a new fully automated deep learning based aortic segmentation algorithm that could be used for optimised digital twin generation.

Methods

After training on 1280 computed tomography angiography scans, including 1000 for pre-training and 280 for fine tuning, a convolutional neural network based on a U-Net architecture was externally validated on 48 computed tomography angiography scans to segment lumen, collateral arteries, ILT, and parietal calcifications of the abdominal aorta and iliac arteries. Blinded, manually corrected segmentations from a senior radiologist and surgeon were performed to create the ground truth comparison.

Results

The comparison between fully automated and manually corrected segmentation methods revealed a mean dice similarity coefficient of 0.97 ± 0.01, 0.94 ± 0.05, and 0.87 ± 0.04 for aortic lumen, ILT, and calcifications, respectively. Average surface distance was 0.30 ± 0.15, 0.61 ± 0.72, and 0.28 ± 0.28 mm for aortic lumen, ILT, and calcifications, respectively. Mean segmentation time was four minutes and 20 seconds with the fully automated method.

Conclusion

The deep learning algorithm developed in this study provided valid, fast, and accurate aorto-iliac segmentation. This may be used to automatically generate reliable aortic digital twins for endovascular aortic repair planning.
目的人工智能和数字孪生技术为规划血管内介入提供了一种新的方法,可以帮助从业者预测并发症。这些方法的准确性基于可靠的自动主动脉分割,包括腔内血栓(ILT)、钙化和侧支动脉的检测。本研究的目的是验证一种新的基于全自动深度学习的主动脉分割算法,该算法可用于优化数字双胞胎的生成。方法在1280个计算机断层血管造影扫描(1000个预训练和280个微调)上进行训练后,基于U-Net架构的卷积神经网络在48个计算机断层血管造影扫描上进行外部验证,以分割管腔、侧支动脉、ILT和腹主动脉和髂动脉的顶叶钙化。由资深放射科医生和外科医生进行盲法、手动校正的分割,以创建真实的比较。结果全自动分割与人工分割的相似系数分别为0.97±0.01、0.94±0.05和0.87±0.04。主动脉腔、ILT和钙化的平均表面距离分别为0.30±0.15、0.61±0.72和0.28±0.28 mm。全自动分割法平均分割时间为4分20秒。结论本研究开发的深度学习算法能够有效、快速、准确地分割主动脉-髂动脉。这可用于自动生成可靠的主动脉数字双胞胎,用于血管内主动脉修复计划。
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引用次数: 0
Endovascular Management of Right Renal Vein Thrombosis Involving Inferior Vena Cava Using an Intelligent Aspiration System 应用智能抽吸系统处理累及下腔静脉的右肾静脉血栓形成
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-11-04 DOI: 10.1016/j.ejvsvf.2025.10.003
Vincenzo Ardita , Domenico Baccellieri

Introduction

Renal vein thrombosis (RVT) is a rare but potentially serious condition, particularly when extending into the inferior vena cava (IVC). It can arise from nephrotic syndrome, hypercoagulable states, or infection, and may compromise renal function or lead to embolic complications. While anticoagulation remains the cornerstone of therapy, endovascular mechanical thrombectomy is emerging as a viable option in selected cases. This case report describes a right RVT with IVC involvement that was successfully treated with a new generation aspiration device.

Report

A 60 year old man with recent pyelonephritis presented with nephrotic range proteinuria, microhaematuria, and normal renal function. Computed tomography imaging revealed a 4 cm thrombus in the right renal vein extending into the IVC. Following anticoagulation with low molecular weight heparin and exclusion of thrombophilia or malignancy, the patient underwent urgent endovascular thrombectomy using the Penumbra Lightning 12 system. Dual venous access via the right internal jugular and femoral veins allowed aspiration under intravascular ultrasound guidance. Two aspiration passes achieved complete thrombus removal, which was confirmed by phlebography and follow up duplex ultrasound. No malignancy was found on histology. The patient was discharged with preserved renal function and showed complete thrombus resolution at one month imaging follow up.

Discussion

This case demonstrates the feasibility and effectiveness of mechanical thrombectomy for RVT with IVC extension using the Penumbra Lightning 12 system. Originally developed for pulmonary embolism, this large lumen aspiration catheter enables efficient thrombus removal with minimal blood loss. In this patient, the procedure led to rapid vessel clearance, avoidance of thrombolytics, and excellent short term outcomes. The case highlights the expanding role of advanced endovascular techniques in managing complex venous thromboses and supports a multidisciplinary approach. Further studies are needed to define the optimal indications and outcomes for such interventions in renal vein thrombosis.
肾静脉血栓形成(RVT)是一种罕见但潜在的严重疾病,特别是当它延伸到下腔静脉(IVC)时。它可由肾病综合征、高凝状态或感染引起,并可能损害肾功能或导致栓塞并发症。虽然抗凝仍然是治疗的基石,但在某些情况下,血管内机械取栓正在成为一种可行的选择。本病例报告描述了一个右RVT与下腔静脉受累,成功地治疗了新一代的抽吸装置。报告一例60岁男性肾盂肾炎患者,表现为肾病范围蛋白尿、微量血尿和肾功能正常。计算机断层成像显示右肾静脉4厘米血栓延伸至下腔静脉。在使用低分子肝素抗凝并排除血栓形成或恶性肿瘤后,患者使用半影闪电12系统进行了紧急血管内血栓切除术。双静脉通道通过右颈内静脉和股静脉,允许在血管内超声引导下抽吸。通过两次抽吸,血栓完全清除,并通过静脉造影和随访双工超声证实。组织学未见恶性肿瘤。患者出院时肾功能完好,并在一个月的影像学随访中显示血栓完全消退。本病例证明了使用半影闪电12系统进行机械取栓术治疗下腔静脉扩张RVT的可行性和有效性。最初是为肺栓塞而开发的,这种大管腔抽吸导管能够以最小的失血有效地清除血栓。在该患者中,该手术导致了快速的血管清除,避免了溶栓,以及良好的短期预后。该病例强调了先进血管内技术在管理复杂静脉血栓中的作用,并支持多学科方法。需要进一步的研究来确定肾静脉血栓形成的最佳适应症和结果。
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引用次数: 0
Unexpected Diagnosis of Concomitant Castleman's Disease Following Carotid Body Tumour Resection: A Case Report and Management Review. 颈动脉体肿瘤切除术后并发Castleman病的意外诊断:一例报告和管理回顾。
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-05-24 eCollection Date: 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.05.008
Roberto Cunha, Roberto Silva, Clara Nogueira, Alexandra Canedo

Introduction: Castleman's disease is a rare lymphoproliferative disorder with distinct histopathological features. Although some non-specific imaging findings may suggest this pathology, the diagnosis remains challenging due to its rarity and often asymptomatic presentation.

Report: The case of a patient submitted to surgical resection of an assumed carotid body tumour, but whose histological examination revealed a paraganglioma and presence of Castleman's disease in the cervical lymph nodes is presented.

Discussion: The management and treatment options for this disease are reviewed in this report, which aims to raise awareness among surgeons involved in cervical tumour pathology about this rare pathology.

简介:Castleman病是一种罕见的淋巴细胞增生性疾病,具有独特的组织病理学特征。虽然一些非特异性影像学结果可能提示这种病理,但由于其罕见且通常无症状表现,诊断仍然具有挑战性。报告:病例的病人提交手术切除假定颈动脉体肿瘤,但其组织学检查显示副神经节瘤和存在的颈淋巴结Castleman病是提出。讨论:本报告回顾了本病的管理和治疗方案,旨在提高参与宫颈肿瘤病理的外科医生对这种罕见病理的认识。
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引用次数: 0
Anastomotic Pseudoaneurysm in an Abandoned Brachiocephalic Arteriovenous Fistula 吻合假性动脉瘤一例放弃的头臂动静脉瘘
IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2024.12.002
Arianna Serra , Elisabetta Tanda
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引用次数: 0
期刊
EJVES Vascular Forum
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