EJVES Vascular Forum最新文献

英文中文

A Physician Made Biological Stent Graft for the Replacement of a Left Renal Vein Leiomyosarcoma 医师制造生物支架置换左肾静脉平滑肌肉瘤

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.09.006

Francesca Maria Feroldi , Bruno Gargiulo , Magali Fau , Xavier Berard

Introduction

Primary venous leiomyosarcoma is an unusual and aggressive tumour; its presentation on the renal vein is rare. This case study presents a 50 year old man with severe obesity who was incidentally diagnosed with a left renal vein leiomyosarcoma during pre-operative evaluations for a cholecystectomy. Following a multidisciplinary discussion with oncology and vascular surgeons, the patient underwent complete resection of the left renal vein along with the mass.

Technique

This article proposes an innovative surgical technique for the reconstruction of the left renal vein in case of a left renal vein leiomyosarcoma. Reconstruction was achieved using a physician made biological stent graft, employing a nitinol bare stent wrapped in a pericardial patch. The video provides a step by step explanation of the procedure. Isolation and the surgical technique for the reconstruction of the left renal vein following en bloc resection of the leiomyosarcoma are shown, followed by reconstruction of the vein using a nitinol stent covered with bovine pericardium. Several precautions were adopted to minimise the risk of intestinal fistula, including heterotopic graft re-implantation and omentoplasty.

Discussion

Complete surgical excision remains the cornerstone of vein sarcoma treatment and offers the best chance for disease control. The literature has only reported en bloc resection of renal vein sarcomas with nephrectomy. This case report presents an innovative surgical technique for left renal vein replacement, showing a potential alternative in the management of this rare condition in order to preserve the vein.

原发性静脉平滑肌肉瘤是一种罕见的侵袭性肿瘤；它在肾静脉的表现是罕见的。这个病例研究报告了一个50岁的严重肥胖的男人，他在胆囊切除术的术前评估中偶然被诊断为左肾静脉平滑肌肉瘤。在与肿瘤学和血管外科医生进行多学科讨论后，患者接受了左肾静脉和肿块的完全切除。本文提出一种创新的左肾静脉平滑肌肉瘤重建左肾静脉的手术技术。重建是使用医生制作的生物支架移植，采用镍钛诺裸露支架包在心包贴片。该视频对该程序进行了一步一步的解释。本文显示了平滑肌肉瘤整体切除后左肾静脉的分离和重建手术技术，随后使用牛心包覆盖的镍钛诺支架重建静脉。采取了几种预防措施，以尽量减少肠瘘的风险，包括异位移植物再植入术和网膜成形术。完全手术切除仍然是静脉肉瘤治疗的基石，并提供了控制疾病的最佳机会。文献只报道了整体切除肾静脉肉瘤与肾切除术。本病例报告提出了一种创新的左肾静脉置换手术技术，显示了一种潜在的替代方法来治疗这种罕见的情况，以保留静脉。

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引用次数: 0

Defying the Clock: Restoring Renal Function After 72 Hours of Subacute Renal Thrombosis 对抗时间：在亚急性肾血栓形成72小时后恢复肾功能

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.09.004

Roberto Cunha , Nuno Coelho , Alexandra Canedo

Introduction

Acute renal artery occlusion, especially of thrombotic origin, is rare and often challenging to diagnose. Although early revascularisation is generally recommended, the optimal timing of intervention, especially beyond six hours, remains uncertain.

Report

A 51 year old man, an active smoker, with a history of ST elevation myocardial infarction and previous triple coronary artery bypass grafting, hypertension, and dyslipidaemia, developed subacute renal artery thrombosis. He presented to the emergency department, with non-specific symptoms, >72 hours after symptom onset. Computed tomography angiography confirmed right renal artery occlusion with preserved distal arterial patency and contrast enhancement of the renal parenchyma, except in the lower third of the kidney. Endovascular revascularisation was performed with primary placement of a covered stent (Advanta 5×22 mm), resulting in improved estimated glomerular filtration rate (eGFR) from 30 to 77 mL/min/1.73 m². At the six month follow up, there were no recurrent symptoms, and laboratory results showed eGFR >90 mL/min/1.73 m².

Discussion

A thrombotic aetiology was presumed, based on the patient's cardiovascular history, smoking status, atherosclerotic changes in the renal arteries, and absence of dysrhythmias. While standard practice favours revascularisation within six hours, this case supports that delayed intervention may still be effective in thrombotic occlusions. This aligns with emerging evidence from fenestrated endovascular aortic repair related renal artery thrombosis, which shows favourable outcomes despite delayed treatment. Clinical decisions should therefore consider factors such as preserved renal parenchyma perfusion and distal arterial patency. Timing of revascularisation should be individualised, rather than strictly time dependent.

急性肾动脉闭塞，特别是血栓性的，是罕见的，往往具有挑战性的诊断。虽然通常推荐早期血运重建，但干预的最佳时机，特别是超过6小时，仍然不确定。报告：51岁男性，活跃吸烟者，ST段抬高型心肌梗死病史，既往三冠状动脉搭桥术，高血压，血脂异常，发生亚急性肾动脉血栓形成。他在症状出现72小时后以非特异性症状就诊于急诊科。计算机断层血管造影证实右肾动脉闭塞，保留远端动脉通畅，肾实质增强，除了肾的下三分之一。血管内血管重建术通过首次放置覆盖支架（Advanta 5×22 mm）进行，导致估计肾小球滤过率（eGFR）从30提高到77 mL/min/1.73 m2。随访6个月，无复发症状，实验室eGFR = 90 mL/min/1.73 m2。根据患者的心血管病史、吸烟状况、肾动脉粥样硬化改变和无心律失常，推测血栓形成的病因。虽然标准做法倾向于在6小时内进行血运重建，但本病例支持延迟干预对血栓性闭塞可能仍然有效。这与开窗血管内主动脉修复相关肾动脉血栓形成的新证据一致，尽管延迟治疗，但仍显示出良好的结果。因此，临床决定应考虑诸如保留肾实质灌注和远端动脉通畅等因素。血管重建的时机应该个体化，而不是严格依赖于时间。

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引用次数: 0

A Global Survey of Follow Up Imaging After EVAR Reminds Us That We Are Still Speaking Different Languages 一项关于EVAR后随访成像的全球调查提醒我们，我们仍然说着不同的语言

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.10.001

Ruth A. Benson

引用次数: 0

Reasons for Delayed Carotid Endarterectomy for Symptomatic Carotid Stenosis in Norway 2018–2019: A National Audit 挪威2018-2019年症状性颈动脉狭窄延迟颈动脉内膜切除术的原因：国家审计

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.07.003

Martin Altreuther , Celine Harlinn Sørlie , Benedicte Skaug Hansen , Christian Lyng , Karsten Myhre , Toril Rabben , Ramez Bahar , Tonje Berglund , Dorte Bundgaard , Erik Mulder Pettersen

Objective

Symptomatic carotid stenosis is one of the main causes of amaurosis fugax, transient ischaemic attack (TIA), and stroke. National and international guidelines recommend treatment with carotid endarterectomy (CEA) within 14 days of the index event. In Norway, the proportion of patients operated on within 14 days increased from 65% in 2015 to 83% in 2020. A national clinical audit cross sectional study was performed to identify the reasons for delayed CEA that could be addressed by quality improvement.

Methods

Patients operated on by CEA for symptomatic stenosis more than 14 days after the index event in 2018 and 2019 were identified from the Norwegian Registry for Vascular Surgery. The local registrar assessed the reason for the delay, based on the medical record. Possible reasons for delay were categorised as medical reasons, doctor delay, patient delay, and other reasons.

Results

Fourteen units performed 686 CEA for symptomatic stenosis in Norway in the study period, of which 179 (26%) were delayed. Ten units participated in the audit, accounting for 120 of 179 (67%) delayed CEAs. The reason for delay was identified for all patients in the participating units. There was a medical reason for the delay in 23 patients. There was doctor delay in 54 cases, patient delay in 28 cases, and a combination of patient delay and doctor delay in 10 cases. The reason for the delay was travel abroad in five cases.

Conclusion

Delayed CEA for symptomatic stenosis is usually due to doctor delay or patient delay. Medical reasons account for 19% of delayed operations. This implies that quality improvement is feasible by addressing doctor and patient delay. Healthcare providers should implement strategies to decrease the proportion of delayed CEA for symptomatic stenosis. Patient delay should be addressed with regular information campaigns.

目的症状性颈动脉狭窄是隐匿性黑朦、短暂性脑缺血发作（TIA）和脑卒中的主要原因之一。国家和国际指南建议在指数事件发生后14天内进行颈动脉内膜切除术（CEA）治疗。在挪威，14天内接受手术的患者比例从2015年的65%上升到2020年的83%。我们进行了一项全国临床审计横断面研究，以确定可以通过质量改进来解决的CEA延迟的原因。方法从挪威血管外科登记中心（Norwegian Registry for Vascular Surgery）中筛选2018年和2019年因症状性狭窄术后超过14天接受CEA手术的患者。当地登记员根据医疗记录评估了延误的原因。可能的延误原因分为医疗原因、医生延误、患者延误和其他原因。结果在研究期间，挪威有14个单位对症状性狭窄进行了686例CEA，其中179例（26%）延迟。有10个单位参加了审计，占179个延期CEAs中的120个（67%）。在参与单位的所有患者中确定了延迟的原因。23名病人的延误是有医疗原因的。医生延误54例，患者延误28例，患者和医生共同延误10例。延误的原因是有五次出国旅行。结论有症状性狭窄的迟发性CEA多因医生或患者延误所致。医疗原因占手术延迟的19%。这意味着通过解决医患延误问题，质量改善是可行的。医疗保健提供者应实施策略，以减少延迟CEA的比例症状狭窄。应定期开展宣传活动，解决患者延误问题。

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引用次数: 0

Towards an Off the Shelf Multibranch Device for Endovascular Aortic Arch Repair? 迈向血管内主动脉弓修复的现成多分支装置？

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.06.001

Salomé Kuntz , Nabil Chakfe

引用次数: 0

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01

引用次数: 0

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01

引用次数: 0

Midterm Aortic Neck Evolution after EndoSuture Aneurysm Repair: a Single Centre Retrospective Analysis 动脉瘤内缝合修复后中期主动脉颈部演变：单中心回顾性分析

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.09.002

Raffaele Pio Ammollo , Nicolas Mauchien , Alexandre Oliny , Marine Bordet , Nellie Della Schiava , Antoine Millon

Objectives

Long term results from large international registries have shown satisfactory results in terms of type 1 endoleak (EL1a) prevention and sac shrinkage using EndoSuture aneurysm repair (ESAR) in patients with a hostile aortic neck; however, little is known about the midterm behaviour of the aortic neck after ESAR.

Methods

This study retrospectively analysed the aortic neck evolution and overall results of ESAR procedures performed at this institution between September 2017 and August 2020. Patients with a hostile aortic neck, and or who were unfit for elective open repair, and or presented with abdominal aortic target vessel or iliac anatomy unsuitable for a fenestrated endograft (FEVAR), and or for whom there was insufficient time for FEVAR manufacturing were included.

Results

Twenty-three patients were included (male 22/23, 96%; median age 75 years, range 58–87 years), and were followed up for 36.5 ± 16.3 months. Technical and procedural success rates were 100% and 96%, respectively. No aortic rupture or dissection was encountered peri-operatively and no displacement, migration, or unachieved penetration of the EndoAnchors was observed. The median operating time was 145 (range 87–236) minutes. No aortic neck dilation was observed at six, 12, 24, and 36 months. There was no persistent or new EL1a or limb occlusion. The 30 day and one year mortality rate was 0%. Six non-aneurysm related deaths were observed during follow up (26%). The overall survival at one, two, and three years was 100%, 100%, and 74%, respectively.

Conclusion

This analysis of aortic neck evolution three years after ESAR suggests that EndoAnchors may help prevent aortic neck and suprarenal aortic dilatation in the midterm, without re-interventions for type EL1a. ESAR is a feasible procedure in patients with hostile aortic neck, and/or who are unfit for open surgery, and/or in whom anatomical or technical constraints prevent the use of FEVAR.

大型国际注册的长期结果显示，在敌对主动脉颈患者中使用EndoSuture动脉瘤修复（ESAR）预防1型内漏（EL1a）和囊收缩方面取得了令人满意的结果；然而，对ESAR后主动脉颈部的中期表现知之甚少。方法本研究回顾性分析2017年9月至2020年8月在该机构进行的ESAR手术的主动脉颈部演变和总体结果。包括主动脉颈部不稳定，或不适合选择性开放式修复，或腹主动脉靶血管或髂解剖结构不适合开窗内植骨（FEVAR），或没有足够时间制造FEVAR的患者。结果共纳入23例患者，男性22/23例，占96%，中位年龄75岁，范围58 ~ 87岁，随访36.5±16.3个月。技术和手术成功率分别为100%和96%。术中未发生主动脉破裂或夹层，EndoAnchors未发生移位、移动或未穿透。中位手术时间为145分钟（范围87-236）。6个月、12个月、24个月和36个月均未观察到主动脉颈部扩张。没有持续或新的EL1a或肢体闭塞。30天和1年死亡率均为0%。随访期间观察到6例与动脉瘤无关的死亡（26%）。1年、2年和3年的总生存率分别为100%、100%和74%。结论：对ESAR后3年主动脉颈演变的分析表明，endoanchor可能有助于预防中期主动脉颈和肾上主动脉扩张，而无需对EL1a型患者进行再次干预。ESAR是一种可行的手术方法，适用于主动脉颈部病变，和/或不适合开放手术，和/或解剖或技术限制不能使用FEVAR的患者。

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引用次数: 0

Left Ovarian Vein Transposition to Restore Renal Venous Outflow in a Patient With Severe Pelvic Congestion After Multiple Endovascular and Failed Open Procedures for Nutcracker Syndrome 左卵巢静脉转位恢复肾静脉流出在胡桃夹子综合征患者多次血管内和失败的开放手术后严重盆腔充血

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.09.001

Fiorenza De Lisio, Domenico Baccellieri, Roberto Chiesa

Introduction

Nutcracker syndrome (NCS) results from compression of the left renal vein between the superior mesenteric artery and aorta, leading to impaired venous outflow. This rare condition may cause a spectrum of symptoms, including haematuria, abdominal or pelvic pain, and features of pelvic congestion. Although endovascular stenting is a common treatment, it carries the risk of significant complications.

Report

A 29 year old woman presented with severe pelvic pain, left flank discomfort, and lower extremity oedema. Her history included a diagnosis of NCS treated by left renal vein (LRV) stenting, which was complicated by stent migration into the inferior vena cava that required open surgical removal and LRV re-implantation. This procedure was further complicated by retroperitoneal bleeding that necessitated surgical evacuation. At presentation, imaging revealed thrombosis of the reconstructed LRV and a markedly dilated left ovarian vein (LOV), which had become the main renal outflow pathway. Endovascular recanalisation of the reconstruction was attempted but failed. The patient subsequently underwent open surgical transposition of the LOV to the left external iliac vein via an extraperitoneal approach. Post-operative imaging confirmed patency of the transposed vessels and the patient experienced significant symptom relief.

Discussion

Nutcracker syndrome can present diagnostic and therapeutic challenges, especially in patients with previous failed interventions. While endovascular techniques are less invasive, they may be associated with serious complications, including stent migration. In selected cases, open surgery remains a valuable option. Transposition of the LOV to the external iliac vein may represent a feasible and effective alternative in patients with suitable anatomy and failure of other options.

胡桃夹子综合征（NCS）是由于肠系膜上动脉和主动脉之间的左肾静脉受到压迫，导致静脉流出受损而引起的。这种罕见的情况可引起一系列症状，包括血尿、腹部或盆腔疼痛，以及盆腔充血的特征。虽然血管内支架植入术是一种常见的治疗方法，但它有明显并发症的风险。报告一名29岁女性，表现为严重骨盆疼痛，左侧腹部不适和下肢水肿。她的病史包括经左肾静脉（LRV）支架治疗的NCS，并伴有支架迁移至下腔静脉，需要开放手术切除和LRV重新植入。腹膜后出血使手术进一步复杂化，需要手术撤离。影像学显示重建的LRV血栓形成，左卵巢静脉（LOV）明显扩张，成为主要的肾流出通道。尝试重建血管内再通，但失败。患者随后通过腹腔外入路将左髂外静脉转位至左髂外静脉。术后影像学证实转位血管通畅，患者症状明显缓解。胡桃夹子综合征可以提出诊断和治疗的挑战，特别是在患者以前的干预失败。虽然血管内技术的侵入性较小，但它们可能与严重的并发症相关，包括支架移位。在某些情况下，开放手术仍然是一个有价值的选择。对于解剖结构合适且其他选择失败的患者，将LOV转置至髂外静脉可能是一种可行且有效的选择。

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引用次数: 0

Remember Chylous Ascites After Open Aneurysm Repair 记得开放性动脉瘤修复后乳糜腹水

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.05.007

Arindam Chaudhuri

引用次数: 0

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