EJVES Vascular Forum最新文献_第3页

Endovascular Aneurysm Sealing: Sealed, Signed, Disposed? 血管内动脉瘤密封：密封、签名、处理？

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.05.006

Martin Teraa, Joost A. van Herwaarden

引用次数: 0

Sartorius and Gracilis Muscle Flaps as Adjuncts for the Management of Complicated Femoral Wounds in Vascular Surgery 缝匠肌和股薄肌瓣在血管外科治疗复杂股伤口中的辅助作用

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.03.004

Jhanvi Dholakia , Anantha Narayanan , Qiantai Hong , Manar Khashram

Aim

Groin complications following vascular surgery occur in 10–30% of cases and are associated with significant morbidity and mortality rates. While various institutions have published results on sartorius and rectus femoris muscle flaps for arterial reconstruction coverage, there are limited data on the use of gracilis muscle flaps. This study aimed to present the outcomes of sartorius and gracilis muscle flaps in managing complicated femoral wounds.

Method

A retrospective study was conducted from January 2019 to December 2023 at a tertiary centre in New Zealand. The study design followed the STrengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist. Patients who underwent a muscle flap for an emergency vascular surgery indication were included. The primary outcome was wound healing, while secondary outcomes included re-intervention, limb and graft salvage.

Results

Twenty-three flaps were performed for post-operative complications during the study period, including 10 gracilis flaps and 13 sartorius flaps, with a median follow up of twenty-six months. Complete healing was achieved in 90% of patients in the gracilis group, compared with 69% in the sartorius group (p = 0.34). The median time to healing was 56 days in the gracilis group and 55 days in the sartorius group. Three patients in the sartorius group underwent planned re-intervention for groin debridement, compared with two in the gracilis group. Donor site wound complications occurred in two gracilis flap patients, both of which healed. Major complications in the sartorius group included two amputations and one graft occlusion, while no such event occurred in the gracilis group.

Conclusion

Both gracilis and sartorius muscle flaps are viable options for reconstructing femoral wounds, with reasonable post-operative outcomes. Further multicentre studies are needed to better correlate clinical outcomes with the perceived benefits of the gracilis flap.

血管手术后的腹股沟并发症发生在10-30%的病例中，并与显著的发病率和死亡率相关。虽然许多机构已经发表了关于缝阔肌和股直肌皮瓣用于动脉重建覆盖的结果，但关于股薄肌皮瓣使用的数据有限。本研究旨在介绍缝匠肌和股薄肌瓣在治疗复杂股外伤中的效果。方法回顾性研究于2019年1月至2023年12月在新西兰某高等教育中心进行。研究设计遵循加强流行病学观察性研究报告（STROBE）检查表。因急诊血管手术指征而行肌肉瓣手术的患者也包括在内。主要结局是伤口愈合，次要结局包括再干预、肢体和移植物保留。结果研究期间共行23例皮瓣修复术后并发症，其中股薄肌皮瓣10例，缝匠肌皮瓣13例，中位随访26个月。股薄肌组90%的患者完全愈合，而缝匠肌组为69% （p = 0.34）。股薄肌组的中位愈合时间为56天，缝匠肌组的中位愈合时间为55天。缝匠肌组有3例患者接受了计划的腹股沟清创再干预，而股薄肌组只有2例。2例薄股肌皮瓣患者出现供区创面并发症，均愈合。缝匠肌组的主要并发症包括2例截肢和1例移植物闭塞，股薄肌组未发生此类事件。结论股薄肌瓣和缝匠肌瓣是重建股外伤的可行选择，术后效果良好。需要进一步的多中心研究来更好地将临床结果与股薄肌皮瓣的感知益处联系起来。

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引用次数: 0

Emergency Repair of a Symptomatic Arch Aneurysm due to a Type B Aortic Dissection Using a Repurposed Three Vessel Branched Endograft 三支血管内移植术急诊修复B型主动脉夹层所致症状性拱性动脉瘤

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.06.002

Prakash Saha, Mohamed H. Sayed, Said Abisi

Introduction

Thoracic endovascular aortic repair (TEVAR) has replaced open surgery for descending thoracic aortic pathology. Achieving a suitable proximal seal may necessitate hybrid repair involving cervical debranching, which carries risks. Alternatively, if a total endovascular solution is being attempted, parallel grafts or physician modified devices can be used. These have not, however, been designed specifically for this purpose. Branched thoracic endografts represent an evolution in stent graft design for the aortic arch. Single branched off the shelf designs are available, but multibranched designs are custom made, limiting their emergency use. Here, the successful use of a repurposed custom made triple branched endograft for a complicated acute type B aortic dissection (TBAD) with rapid false lumen expansion is reported.

Report

An 84 year old man presented with a three day history of chest pain and worsening breathlessness. He had had a previous episode of acute TBAD a month earlier, managed with blood pressure control. Computed tomography angiography (CTA) revealed a left pleural effusion and an aortic dissection extending from the left subclavian artery to the aortic bifurcation. The proximal descending aortic diameter had rapidly expanded to 67 mm. To treat the patient, a custom made triple branched endograft, initially intended for a different patient, was used. Follow up CTA showed satisfactory positioning of the stent graft with no evidence of endoleak, complete false lumen thrombosis, and satisfactory aortic remodelling.

Discussion

Acute TBAD remains a significant therapeutic challenge, especially when complications arise. TEVAR is recommended, but standard endografts may require full head and neck vessel debranching to ensure a proximal seal, which can be achieved by either open surgery or through endovascular means. This case demonstrates the applicability of a multibranched arch endograft in the emergency setting, which fortunately was available in the unit. Although these cases are rare, it is believed that development of a three vessel off the shelf solution should be considered.

胸降主动脉病变的血管内主动脉修复术（TEVAR）已取代开放手术。为了获得合适的近端封闭，可能需要混合修复，包括颈椎去分支，这有风险。另外，如果正在尝试全血管内解决方案，可以使用平行移植物或医生修改的设备。然而，这些并不是专门为此目的而设计的。分支胸椎内移植物代表了主动脉弓支架移植设计的发展。单分支的现成设计是可用的，但多分支的设计是定制的，限制了它们的紧急使用。在这里，我们成功地使用了一种定制的三支内移植物来治疗伴有快速假腔扩张的复杂急性B型主动脉夹层（TBAD）。报告一名84岁男性，胸痛及呼吸困难加重3天。一个月前，他曾有过一次急性TBAD发作，并控制了血压。计算机断层血管造影（CTA）显示左侧胸腔积液和主动脉夹层，从左侧锁骨下动脉延伸至主动脉分叉处。降主动脉近端直径迅速扩大至67毫米。为了治疗患者，使用了一种定制的三支内移植物，最初是为不同的患者设计的。随访CTA显示支架定位良好，无内漏、假腔血栓形成，主动脉重构满意。急性TBAD仍然是一个重大的治疗挑战，特别是当并发症出现时。推荐采用TEVAR，但标准的内移植物可能需要完全去除头颈部血管分支以确保近端密封，这可以通过开放手术或血管内方法实现。本病例证明了多支弓内移植物在急诊情况下的适用性，幸运的是在该单位可以获得。虽然这些情况很少见，但人们认为应该考虑开发三艘船的现成解决方案。

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引用次数: 0

Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience 胸腔血管内主动脉修复后的开放主动脉修复：从单中心手术经验的战略见解

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2024.12.001

Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Tsuyoshi Shibata, Shuhei Miura, Nobuyoshi Kawaharada

Objective

Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated.

Methods

This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: n = 4, type II: n = 1, type V: n = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%).

Results

Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%).

Conclusion

When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement.

目的胸主动脉血管内修复术（TEVAR）在胸主动脉手术中应用广泛。然而，由于各种原因，一些患者需要二次主动脉切开修复。本文就TEVAR后开放性转换手术的手术效果及存在的问题进行探讨。方法回顾性观察性研究。从2010年1月到2022年6月，纳入了20例在TEVAR后接受开放主动脉修复的患者。开放转换手术的适应症如下：7例患者因内漏（EL）导致主动脉扩张(Ia型：n = 4例，II型：n = 1例，V型：n = 2例；35%)，支架感染包括主动脉-食管瘘（AEF） 6例（30%），逆行A型主动脉夹层（RTAD） 3例（15%），邻近远端主动脉扩张或假腔4例（20%）。结果7例Ia型EL或RTAD患者需开腹主动脉弓修复。4例因主动脉远端扩大而行胸腹主动脉修补术。6例感染患者和2例V型EL患者均行降主动脉置换术。此外，3例AEF患者同时接受了食管切除术。1例持续性II型EL患者通过开胸行肋间动脉结扎和动脉瘤吻合术。住院死亡2例（10%），均为急性心衰。因此，非感染病例的住院死亡率为0%，移植物感染为33%，AEF患者为66%。脑卒中和截瘫2例（10%）。结论TEVAR术后需要开腹转换手术时，适应症复杂，常与感染性病理相关，且必然存在高风险，尤其是AEF患者。手术策略必须根据并发症的性质或原因以及主动脉受累程度进行个体化治疗。

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引用次数: 0

When and How to Perform Open Aortic Repair After Thoracic Endovascular Repair Complications? 胸血管内修复并发症后何时及如何进行主动脉切开修复？

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.01.004

Paulo Eduardo Ocke Reis , Arindam Chaudhuri

引用次数: 0

Imaging Characterisation of Peripheral Artery Disease: A Scoping Review on Current Classifications and New Insights Brought by Artificial Intelligence 外周动脉疾病的影像学表征：对当前分类和人工智能带来的新见解的综述

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.06.003

Fabien Lareyre , Lisa Guzzi , Bahaa Nasr , Ahmed Alouane , Sébastien Goffart , Andréa Chierici , Hervé Delingette , Juliette Raffort

Objectives

Several scan and imaging classifications have been described for the management of patients with peripheral artery disease (PAD). In parallel, artificial intelligence (AI) has brought new insights in vascular imaging analysis. This scoping review aimed to summarise imaging classification for PAD and to discuss how AI could be used to enhance these systems.

Methods

Medline was searched for relevant studies that addressed imaging classification and use of AI in PAD vascular imaging. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) protocol was followed.

Results

Thirty four articles were included. This paper provides an overview and discusses the advantages and limits of current imaging classifications used to characterise atherosclerotic lesions as well as calcifications in patients with PAD. AI offers new opportunities to enhance automatic detection and classification of PAD lesions, with potentially new techniques that could be used to assess vascular calcification and identify radiomic patterns.

Conclusion

AI has brought new opportunities to improve imaging software to facilitate robust and reproducible analysis of lower limb arterial lesions. In the future, such applications may contribute to improved clinical workflow and help decision making.

目的介绍了外周动脉疾病（PAD）患者的几种扫描和影像学分类。与此同时，人工智能（AI）为血管成像分析带来了新的见解。本综述旨在总结PAD的成像分类，并讨论如何使用人工智能来增强这些系统。方法检索medline上有关图像分类和人工智能在PAD血管成像中的应用的相关研究。遵循系统评价和荟萃分析扩展范围评价的首选报告项目（PRISMA-ScR）协议。结果共纳入34篇文献。本文概述并讨论了目前用于PAD患者动脉粥样硬化病变和钙化特征的影像学分类的优点和局限性。人工智能为增强PAD病变的自动检测和分类提供了新的机会，其潜在的新技术可用于评估血管钙化和识别放射学模式。结论人工智能为改进成像软件提供了新的机会，有助于对下肢动脉病变进行稳健、可重复的分析。在未来，这样的应用可能有助于改善临床工作流程和帮助决策。

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引用次数: 0

Proximal Relining with Custom Made Double Branch Aortic Arch Graft to treat a type Ia Endoleak after Zone 2 Branched TEVAR 定制双支主动脉弓近端修补治疗2区支化TEVAR术后Ia型腔隙

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.04.004

Simona Sica , Jonathan Sobocinski

Objective

Thoracic endovascular aortic repair (TEVAR) including a branch or fenestration offers a less invasive alternative to open surgery in the treatment of aortic arch pathologies. Nevertheless, the occurrence of a proximal type I endoleak (EL) in this specific setting may be particularly challenging to fix. This study presents the case of a type Ia endoleak after a zone 2 single branched TEVAR that was successfully treated with a proximal endovascular relining using a custom made double branch aortic arch graft.

Case

A 74 year old male presented with a 70 mm thoracic aortic aneurysm and a type Ia EL 7 years after a zone 2 TEVAR including a retrograde left subclavian artery branch. After multidisciplinary discussion, the patient underwent a hybrid repair with left carotid subclavian bypass and a custom made double branch aortic arch graft to extend proximal sealing into zone 0. The device that was used featured two antegrade inner branches for the brachiocephalic trunk and left common carotid artery. Post-operatively, the patient recovered well without neurological deficit. Follow-up imaging at three months confirmed patency of the supra-aortic trunks and favourable aortic remodelling without any residual endoleak.

Conclusion

This case suggests that proximal endovascular relining in zone 0 with a custom made double branch aortic arch for treating type Ia endoleak following left subclavian artery branch endograft is feasible and effective in experienced aortic centres.

目的胸腔血管内主动脉修复术（TEVAR）包括分支或开窗，为治疗主动脉弓病变提供了一种创伤较小的手术选择。然而，在这种特殊情况下，近端I型内漏（EL）的发生可能特别具有挑战性。本研究报告了2区单支TEVAR后的Ia型内漏病例，该病例成功地使用定制的双支主动脉弓移植物进行近端血管内修补。病例a， 74岁男性，在2区TEVAR术后7年出现70毫米胸主动脉瘤和Ia型EL，包括左锁骨下动脉分支逆行。经过多学科的讨论，患者接受了左颈动脉锁骨下搭桥和定制双支主动脉弓移植的混合修复，将近端密封扩展到0区。所使用的装置具有头臂干和左颈总动脉的两条顺行内分支。术后患者恢复良好，无神经功能缺损。3个月的随访影像证实主动脉上干通畅，主动脉重构良好，无残余内漏。结论本病例提示在经验丰富的主动脉中心，左锁骨下动脉分支内移植术后，在0区近端血管内修补双支主动脉弓治疗Ia型内漏是可行和有效的。

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引用次数: 0

Objective Perfusion Assessment With Near Infrared Fluorescence for Guidance of Bowel Resection Margins Following Superior Mesenteric Artery Thrombosis: A Case Report 目的用近红外荧光评价肠系膜上动脉血栓形成后肠切缘的灌注情况：1例报告

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.08.006

Roderick C. Peul, Floris P. Tange, Joost R. van der Vorst

Objective

Acute occlusion of the superior mesenteric artery (SMA) results in extensive bowel ischaemia, with mortality rates approaching 70%. Management involves acute revascularisation, typically via embolectomy, and intra-operative evaluation to distinguish viable from non-viable intestinal tissue. Near infrared fluorescence (NIRF) imaging with indocyanine green (ICG) enables real time, minimally invasive assessment of tissue perfusion. This case report illustrates the usability of NIRF imaging to guide surgical decision making for bowel preservation and patient survival in a clinical situation where research is limited.

Report

A 40 year old male presented, in June 2023, with severe postprandial abdominal pain. Imaging revealed a non-occlusive thrombus in the SMA, which together with clinical deterioration resulted in an emergency embolectomy. Intra-operative NIRF imaging with ICG identified malperfusion of a jejunal segment. A second NIRF assessment post-embolectomy confirmed persistent malperfusion, guiding resection with a primary anastomosis. Quantitative fluorescence analysis confirmed the intra-operative findings of malperfusion and demonstrated potential utility for objective perfusion assessment to resect non-viable tissue and limit viable tissue resection. The patient recovered uneventfully and was discharged on post-operative day five.

Discussion

This case highlights the use of NIRF imaging as a safe, low cost technique for evaluating bowel perfusion during SMA embolectomy. By selecting adjacent regions of interest, surgeons can compare objective perfusion curves intra-operatively and select optimal anastomosis sites. Quantified parameters further aid decision making, showing clear percentage differences in perfusion between viable and ischaemic tissue. Although standardised cut off values are lacking, combining clinical evaluation, subjective assessment, and quantitative data offers a patient tailored approach to optimising resection margins.

目的肠系膜上动脉（SMA）急性闭塞导致广泛的肠缺血，死亡率接近70%。治疗包括急性血运重建，通常通过栓塞切除术，术中评估以区分活的和非活的肠道组织。近红外荧光（NIRF）成像与吲哚菁绿（ICG）能够实时，微创评估组织灌注。本病例报告说明了在研究有限的临床情况下，NIRF成像在指导肠保存和患者生存的手术决策方面的可用性。报告一名40岁男性，于2023年6月出现严重餐后腹痛。影像学显示SMA有非闭塞性血栓，再加上临床恶化，导致紧急栓塞切除术。术中含ICG的NIRF成像发现空肠段灌注不良。栓塞切除术后的第二次NIRF评估证实了持续的灌注不良，指导了原发性吻合切除术。定量荧光分析证实了术中灌注不良的发现，并证明了客观灌注评估在切除非活组织和限制活组织切除方面的潜在效用。患者顺利恢复，术后第5天出院。本病例强调了在SMA栓塞切除术中使用NIRF成像作为一种安全、低成本的技术来评估肠灌注。通过选择邻近感兴趣的区域，外科医生可以比较术中客观的灌注曲线，选择最佳的吻合位置。量化参数进一步帮助决策，显示活组织和缺血组织之间灌注的明显百分比差异。虽然缺乏标准化的切缘值，但结合临床评估、主观评估和定量数据，为优化切除切缘提供了一种适合患者的方法。

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引用次数: 0

Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia 放射性核素血管造影评估的慢性肢体威胁性缺血患者足部微循环的有效性和强度与一年肢体预后之间的关系

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2024.11.002

Takuya Hashimoto , Yoshitaka Kumakura , Kenichi Ichikawa , Satoshi Yamamoto , Takashi Endo , Masaya Sano , Osamu Sato , Juno Deguchi

Objective

Microcirculation focused evaluations may provide physiological insights that complement those of the established clinical criteria for patients with chronic limb threatening ischaemia (CLTI), since complex treatments are needed in this high risk population. However, current methods for quantitatively assessing foot microcirculation are limited. Thus, in this study, the aim was to demonstrate a proof of concept non-invasive method with novel parameters for assessing foot microcirculation.

Methods

This was a single centre prospective cohort pilot study. The lower limbs of 13 patients diagnosed with CLTI were evaluated by radionuclide (RN) angiography with ^99mTc-tetrofosmin two weeks after revascularisation or non-revascularisation procedures. Novel parameters (pedal transit time and peak pedal count) were derived by processing the time–activity curves of the detected tracers in each region of interest in the limbs. The Mann–Whitney U test was used for the analysis of associations between these two parameters and limb fate at one year, and Pearson and Spearman tests were used to analyse associations with transcutaneous partial oxygen pressure (tcPO₂), a conventional perfusion test result.

Results

The mean pedal transit time of the affected limbs in the non-healing group was longer than that in the healing group (19.1 ± 18.6 vs. 2.9 ± 2.1 seconds, p = .001). The mean peak pedal count of nucleotides in the non-healing group was lower than that in the healing group (24.4 ± 19.0 vs. 72.0 ± 36.1 counts/sec/GBq, p = .008). The pedal transit time and peak pedal count showed little to no correlation with the conventional tcPO₂ at the midfoot (r = 0.26 for pedal transit time; r = −0.11 for peak pedal count).

Conclusion

Two novel microcirculation parameters derived from RN angiography were associated with one year limb outcomes in patients with CLTI. Non-invasive radiotracer imaging derived parameters may provide an additional dimension to indices of pathophysiological microcirculation in CLTI.

以微循环为重点的评估可能为慢性肢体威胁性缺血（CLTI）患者的既定临床标准提供生理学见解，因为在这一高风险人群中需要复杂的治疗。然而，目前定量评估足部微循环的方法是有限的。因此，在本研究中，目的是展示一种具有新参数的概念验证无创方法来评估足部微循环。方法本研究为单中心前瞻性队列先导研究。13例诊断为CLTI的患者在进行血管重建或非血管重建手术两周后，采用放射性核素（RN）血管造影术（99mTc-tetrofosmin）对下肢进行评估。通过处理检测到的示踪剂在四肢各感兴趣区域的时间-活性曲线，得到了新的参数（踏板传递时间和峰值踏板计数）。使用Mann-Whitney U检验分析这两个参数与一年后肢体命运之间的关系，使用Pearson和Spearman检验分析与经皮分氧压（tcPO2）的关系，这是一项常规灌注试验结果。结果未愈合组患肢平均踏板传递时间较愈合组长（19.1±18.6 vs 2.9±2.1 s, p = .001）。未愈合组的平均峰值核苷酸计数低于愈合组（24.4±19.0比72.0±36.1计数/秒/GBq， p = 0.008）。踏板传递时间和峰值踏板计数与常规中足tcPO2几乎没有相关性（r = 0.26）；峰值踏板计数R =−0.11)。结论两项新微循环参数与CLTI患者1年肢体预后相关。无创放射性示踪成像衍生参数可以为CLTI病理生理微循环指标提供额外的维度。

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引用次数: 0

Undifferentiated Intimal Sarcoma of the Visceral Aorta With Recurrent Renovisceral Ischaemia Misdiagnosed as Takayasu's Arteritis 复发性肾脏缺血的内脏主动脉未分化内膜肉瘤误诊为高松动脉炎

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.01.002

Martin Wenkel , Kirsten de Groot , Marius Fried , Achim Neufang

Introduction

Malignant tumours of the aorta are a rare disease and often misdiagnosed as they masquerade as wall adjacent thrombus or inflammatory disease. Due to the often delayed diagnosis and the rapidly progressing illness, the outcome is very poor.

Report

A 50 year old female patient who had received coeliac and mesenteric artery stenting followed by an aortomesenteric bypass after stent occlusion two years earlier was treated. After an episode of hypertensive crisis caused by high grade stenosis of the renal arteries and review of previous tissue biopsies the diagnosis of Takayasu's arteritis was established, but the results were inconclusive. When presenting with a penetrating aneurysm of the renovisceral aorta, a complete reconstruction was performed of the renovisceral aorta due to impending rupture. Pre-operative imaging incidentally showed a sarcoma of the femur which was interpreted as an unrelated entity at the time. Finally, two years after the onset of the first symptoms, the diagnosis of an undifferentiated intimal sarcoma was established after extensive histological workup. However, the patient's condition deteriorated too quickly for her to recover as she had already developed multiple distant metastases and she died within three months of surgery.

Discussion

Due to its extreme rarity, this disease is not widely recognised, even among specialists. Accordingly, the patient was initially misdiagnosed and a malignant process was not considered. An accurate diagnosis at the time of the first open surgery might have presented the opportunity for radical resection of the affected aorta. Unfortunately, there are no non-invasive tools available to diagnose intimal sarcoma and, given the rapid progression of the disease, the prognosis remains poor, with a survival of only a few months.

主动脉恶性肿瘤是一种罕见的疾病，常被误诊为临近壁血栓或炎症性疾病。由于常常延误诊断和迅速发展的疾病，结果是非常糟糕的。报告一名50岁女性患者，两年前接受腹腔和肠系膜动脉支架置入术，支架闭塞后又行主动脉肠系膜旁路手术。在肾动脉高度狭窄引起的高血压危象发作后，回顾以往的组织活检，确定了Takayasu动脉炎的诊断，但结果不确定。当出现肾脏器主动脉的穿透性动脉瘤时，由于即将破裂，对肾脏器主动脉进行了完全重建。术前影像偶然发现股骨肉瘤，当时被解释为不相关的实体。最后，在首次症状出现两年后，经过广泛的组织学检查，诊断为未分化的内膜肉瘤。然而，患者的病情恶化太快，无法恢复，因为她已经发生了多处远处转移，并在手术后三个月内死亡。由于极其罕见，这种疾病没有得到广泛的认识，即使在专家中也是如此。因此，患者最初被误诊，没有考虑到恶性过程。在第一次开放手术时的准确诊断可能为根治性切除受影响的主动脉提供了机会。不幸的是，没有可用的非侵入性工具来诊断内膜肉瘤，鉴于疾病的快速进展，预后仍然很差，生存期只有几个月。

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引用次数: 0