EJVES Vascular Forum最新文献_第4页

Re-Thinking Antithrombotic Strategies in Non-Cardiac Arterial Procedures: Time for Standardisation? 重新思考非心脏动脉手术的抗血栓策略：是时候标准化了？

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.03.003

Maria Katsarou , Giuseppe Baldino

引用次数: 0

Feasibility of Portable Laser Doppler Flowmeter for Foot Blood Flow Assessment in Patients With Chronic Limb Threatening Ischaemia 便携式激光多普勒血流计用于慢性肢体缺血性足部血流评估的可行性

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.09.003

Masahiro Tezuka, Shotaro Hirota, Masashi Kawamura, Taisuke Konishi, Ikuko Shibasaki, Hirotsugu Fukuda

Objective

The portable, non-invasive laser Doppler flowmeter (LDF) provides a practical alternative, enabling bedside blood flow assessment for chronic limb threatening ischaemia (CLTI). The present study aimed to evaluate whether LDF could identify CLTI and to assess the utility of LDF in determining the efficacy of revascularisation.

Methods

The study enrolled 50 patients with non–lower extremity arterial disease (LEAD) and 24 patients with CLTI (25 limbs) from March 2021 to December 2024; blood flow in the dorsal and plantar areas was measured using a portable LDF (Pocket LDF, JMS Co., Ltd., Tokyo, Japan). Blood flow and skin perfusion pressure (SPP) were compared before and after surgical bypass, and correlations between LDF and SPP were also determined for 17 limbs with CLTI.

Results

The mean dorsal plantar blood flow was 12.0 ± 9.3 and 13.3 ± 6.6 mL/min for the non-LEAD and CLTI groups, respectively (p = .48), however, the mean plantar blood flow was statistically significant lower in the CLTI group (26.1 ± 11.7 mL/min) than in the non-LEAD group (52.2 ± 18.6 mL/min, p < .001). In the 17 limbs with CLTI that underwent surgical bypass, the mean blood flow in the dorsal area was 13.7 ± 5.5 and 15.7 ± 6.2 mL/min before and after surgery, respectively (p = .30). However, the post-operative mean plantar blood flow improved statistically significant (45.4 ± 18.6 mL/min) from its pre-operative status (25.0 ± 11.8 mL/min, p < .001). The mean SPP changes before and after surgical bypass were 27.3 ± 14.7 and 52.7 ± 18.3 mmHg, respectively (p < .001), in the dorsal area, showing improvement in correlation with the LDF measurements (p = .023).

Conclusion

The portable LDF measurement in the plantar area may help in identifying CLTI and evaluating the effectiveness of revascularisation.

目的：便携式无创激光多普勒血流仪（LDF）为慢性肢体缺血性（CLTI）的床边血流评估提供了一种实用的替代方法。本研究旨在评估LDF是否可以识别CLTI，并评估LDF在确定血运重建疗效方面的效用。方法本研究于2021年3月至2024年12月招募了50例非下肢动脉疾病（LEAD）患者和24例CLTI患者（25条肢体）；使用便携式LDF （Pocket LDF, JMS Co., Ltd, Tokyo, Japan）测量背侧和足底区的血流量。比较17例CLTI肢体手术前后血流量和皮肤灌注压（SPP），并测定LDF与SPP的相关性。结果非铅组和CLTI组的平均足底血流量分别为12.0±9.3和13.3±6.6 mL/min (p = 0.48)，但CLTI组的平均足底血流量（26.1±11.7 mL/min）低于非铅组（52.2±18.6 mL/min, p < 0.001）。17例行搭桥手术的CLTI肢体，术前和术后背区平均血流量分别为13.7±5.5和15.7±6.2 mL/min （p = 0.30）。然而，术后足底平均血流量（45.4±18.6 mL/min）较术前（25.0±11.8 mL/min, p < 0.001）有统计学意义的改善。手术前后背侧SPP的平均变化分别为27.3±14.7和52.7±18.3 mmHg (p < 0.001)，与LDF测量结果相关（p = 0.023）。结论便携式足底LDF测量有助于鉴别CLTI和评价血运重建效果。

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引用次数: 0

Developing a Scanning Electron Microscopy Approach to Evaluate Paclitaxel Deposition From Drug Coated Balloons in a Human Cadaveric Peripheral Artery Disease Model 建立一种扫描电子显微镜方法来评估人类尸体外周动脉疾病模型中药物包被气球紫杉醇沉积

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.06.004

Judit Csore , Alexander B. Crichton , Jianhua Gu , Bright Benfor , Stuart Corr , Kelvin Boateng , Trisha L. Roy

Objective

Drug coated balloons (DCBs) are used to treat peripheral artery disease (PAD) but concerns about their efficacy and safety persist. Current evaluation methods, relying on benchtop studies and animal models, do not replicate the complexity of human PAD lesions. This study aimed to develop a novel methodology to assess paclitaxel delivery from DCBs to human peripheral arteries with complex plaque morphologies using scanning electron microscopy (SEM) with the purpose of examining how plaque morphology and vessel preparation affect drug transfer in human cadaveric legs.

Methods

An amputated leg model from patients with PAD and standardised vessel preparation, imaging, and quantification methods was used. Arteries were treated with plain balloon angioplasty, cutting balloon angioplasty, or no preparation before DCB treatment. Vessels were imaged with high vacuum SEM, and drug coverage was quantified with ImageJ. Lesions were classified as nodular or smooth based on magnetic resonance imaging. Drug distribution was analysed at 300×300 μm field of view (FOV), categorised as minimal, moderate, good, or excellent.

Results

SEM was effective at imaging paclitaxel crystals transferred to the vessel wall. Plaque morphology affected the amount of drug transferred with smooth plaques exhibiting greater drug coverage than nodular plaques. In nodular plaques, drug was concentrated on the protruding portions of the plaque and not in the recesses, while smooth plaques showed more uniform distribution. Excellent coverage was seen in 38.31% of FOVs of smooth plaques vs. 10.58% of nodular plaques. Drug transfer was more consistent in smooth vessels, regardless of vessel preparation method. Cutting balloons enhanced drug delivery when grooves were formed.

Conclusion

This SEM based method effectively evaluated drug transfer in human PAD lesions, revealing greater drug delivery in smooth lesions and the impact of vessel preparation. This novel analytic model offers a platform for optimising DCB strategies to improve PAD patient outcomes.

目的药物包被球囊（DCBs）用于治疗外周动脉疾病（PAD），但其有效性和安全性一直受到关注。目前的评估方法依赖于台式研究和动物模型，不能复制人类PAD病变的复杂性。本研究旨在开发一种新的方法，利用扫描电子显微镜（SEM）来评估紫杉醇从dcb到具有复杂斑块形态的人外周动脉的输送，目的是研究斑块形态和血管制备如何影响人尸体腿部的药物转移。方法采用PAD患者截肢腿模型，采用标准化血管制备、影像学和定量方法。动脉接受普通球囊血管成形术、切开球囊血管成形术或在DCB治疗前不做任何准备。用高真空扫描电镜对血管进行成像，并用ImageJ对药物覆盖进行定量。根据磁共振成像将病变分为结节状或光滑状。在300×300 μm视场（FOV）上分析药物分布，分为极小、中等、良好和极好。结果扫描电镜能较好地显示紫杉醇晶体转移到血管壁上的情况。斑块形态影响药物转移量，平滑斑块比结节斑块表现出更大的药物覆盖。在结节性斑块中，药物集中在斑块的突出部分，而不是在斑块的凹陷部分，而光滑斑块分布更均匀。平滑斑块的fov覆盖率为38.31%，结节斑块为10.58%。无论何种血管制备方法，药物在光滑血管中的转移都更为一致。当形成凹槽时，切割气球可以增强药物的输送。结论基于扫描电镜的方法可以有效地评估人类PAD病变中的药物转移，揭示了平滑病变中更大的药物传递和血管制备的影响。这种新颖的分析模型为优化DCB策略以改善PAD患者的预后提供了一个平台。

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引用次数: 0

Ultrasound Guided Needle Penetration Technique for Recanalisation of Short Segment Chronic Femoral Vein Occlusion 超声引导下针刺短段慢性股静脉阻塞再通技术

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.02.004

Tamás Büki, Vasileios Leivaditis, Manfred Dahm

Introduction

This case report presents an ultrasound guided needle penetration technique as a novel method for the recanalisation of short segment chronic femoral vein occlusion in a patient with a history of intravenous drug use.

Case report

A 41 year old male presented with a painful calf ulcer. Initial ultrasound imaging identified a chronic short segment occlusion in the proximal femoral vein, with extensive scarring from repeated intravenous drug injections. Traditional endovascular approaches were unsuccessful due to dense tissue scarring. The ultrasound guided needle penetration technique was employed to perforate the occlusion, achieving successful wire passage and subsequent stent placement. The patient experienced significant symptomatic relief after the procedure.

Conclusion

This case highlights the feasibility and benefits of ultrasound guided needle penetration as an alternative recanalisation approach in severe scarring peripheral chronic venous occlusion.

本病例报告介绍了一种超声引导下的针穿入技术，作为一种新的方法来重新通短段慢性股静脉阻塞患者的静脉用药史。病例报告一名41岁男性表现为小腿溃疡疼痛。最初的超声成像发现股骨近端静脉慢性短段闭塞，伴有反复静脉注射药物造成的广泛瘢痕。传统的血管内入路由于组织瘢痕较密而不成功。采用超声引导下穿刺针技术穿孔闭塞，成功通过金属丝并置入支架。手术后患者症状明显缓解。结论本病例强调了超声引导下针头穿刺术作为严重瘢痕性外周慢性静脉闭塞的另一种再通方法的可行性和优越性。

引用次数: 0

Aortic Intimal Invagination and Septectomy Following Electrosurgical Septotomy in a Patient With a Type B Dissection B型夹层患者电切开术后主动脉内膜内陷和隔膜切除术1例

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.02.003

Cecilie Markvard Møller, Steen Fjord Pedersen, Jacob Budtz-Lilly

Introduction

Thoracic endovascular aortic repair (T-EVAR) is the standard treatment in patients with a type B aortic dissection and appropriate indications for repair. The procedure requires anatomical, clinical, and technical scrutiny, as well as consideration for potential further repair. Supplementary procedures are not uncommon. Septotomy has received renewed interest as an adjunctive procedure, in the form of electrosurgical techniques, with the objective of improving true lumen landing zones and better access to important target branch vessels. Emerging reports suggest favourable clinical outcomes, although there are associated thromboembolic risks that clinicians should recognise.

Case report

This case report describes an important complication of electrosurgical septotomy causing aortic intimal invagination in a patient with a type B aortic dissection.

Conclusion

Electrosurgical septotomy is an effective method to gain improved landing zones for TEVAR endograft placement, but caution is warranted in the timing of this procedure.

胸主动脉血管内修复术（T-EVAR）是B型主动脉夹层患者的标准治疗方法，有适当的修复指征。该手术需要解剖、临床和技术检查，并考虑潜在的进一步修复。补充手术并不罕见。中隔切开术作为一种辅助手术，以电外科技术的形式重新引起人们的兴趣，目的是改善真正的管腔着陆区，更好地进入重要的目标分支血管。新出现的报告显示了良好的临床结果，尽管有相关的血栓栓塞风险，临床医生应该认识到。病例报告：本病例报告描述了一例B型主动脉夹层患者采用电切开术导致主动脉内膜内陷的重要并发症。结论电鼻中隔切开术是一种有效的方法，可以改善TEVAR内移植物的着落区，但在手术时机上需要谨慎。

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引用次数: 0

Strategies for Antithrombotic Management During Non-cardiac Arterial Procedures: Results of the International ACTION Survey 非心脏动脉手术期间的抗血栓管理策略：国际行动调查的结果

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.01.005

Max Hoebink , Vincent Jongkind

Objective

Peri-procedural antithrombotics are used extensively to prevent thromboembolic complications during non-cardiac arterial procedures (NCAP) worldwide. However, there is a lack of evidence to support recommendations on antithrombotic strategies, possibly leading to substantial variation in local practices. A comprehensive overview of antithrombotic strategies is needed to identify the most widely accepted protocols employed during NCAP, highlight variations in local practices, and identify new research targets to establish evidence based peri-procedural anticoagulation management.

Methods

An international, web based survey study was conducted from March to October 2023, targeting vascular clinical specialists who applied antithrombotic strategies during NCAP in daily practice.

Results

The survey was completed by 436 vascular clinical specialists from 45 countries (Europeans: 93%, vascular surgeons or vascular surgery residents: 98%). Systemic unfractionated heparin was used by nearly all vascular specialists during all procedures (varying between 98–99%, depending on the procedure type), but could vary depending on specific NCAP. A fixed starting dose (39–52%, most often 5 000 IU [80–89%]) or an actual bodyweight dependent dose (42–52%, most commonly 100 IU/kg [40–67%] or 50 IU/kg [17–40%]) was mainly used. Except during fenestrated or branched endovascular aneurysm repair procedures (51%), activated clotting time (ACT) was employed by a minority (26–31%). A large variety in measurement protocols was observed, yet a target ACT of 200 seconds was most often used for all NCAP types (44–54%). Most vascular specialists considered a heparin follow up dose (61–81%) and heparin reversal using protamine (54–63%), both for a variety of indications. Of the participants, 68% expressed discontent with their current antithrombotic protocol(s).

Conclusion

This comprehensive, international survey study revealed large variation among vascular clinical specialists’ heparinisation strategies during NCAP. Together with the considerable discontent expressed regarding protocols, this emphasises the urgent need for comparative, randomised studies on antithrombotic management during NCAP.

目的围术期抗栓药物在世界范围内广泛用于预防非心脏动脉手术（NCAP）中的血栓栓塞并发症。然而，缺乏证据支持关于抗血栓策略的建议，这可能导致地方实践的实质性差异。需要对抗血栓策略进行全面概述，以确定在NCAP期间采用的最广泛接受的方案，突出地方实践的差异，并确定新的研究目标，以建立基于证据的围手术期抗凝管理。方法一项基于网络的国际调查研究于2023年3月至10月进行，目标是血管临床专家在NCAP期间在日常实践中应用抗血栓策略。结果调查由来自45个国家的436名血管临床专家完成，其中欧洲人占93%，血管外科医生或血管外科住院医师占98%。在所有手术过程中，几乎所有血管专科医生都使用了全体性未分离肝素（根据手术类型，在98-99%之间变化），但可能因具体的NCAP而有所不同。主要采用固定起始剂量（39-52%，最常为5 000 IU[80-89%]）或实际体重依赖剂量（42-52%，最常为100 IU/kg[40-67%]或50 IU/kg[17-40%]）。除了开窗或分支血管内动脉瘤修复手术（51%）外，少数（26-31%）采用了激活凝血时间（ACT）。测量方案多种多样，但所有NCAP类型最常使用的目标ACT为200秒（44-54%）。大多数血管专家考虑肝素随访剂量（61-81%）和肝素逆转使用鱼精蛋白（54-63%），这两种适应症都适用。在参与者中，68%的人表示不满意他们目前的抗血栓治疗方案。结论：这项全面的国际调查研究揭示了血管临床专家在NCAP期间的肝素化策略存在很大差异。再加上对方案表达的相当大的不满，这强调了迫切需要对NCAP期间抗血栓管理进行比较，随机研究。

{"title":"Strategies for Antithrombotic Management During Non-cardiac Arterial Procedures: Results of the International ACTION Survey","authors":"Max Hoebink , Vincent Jongkind","doi":"10.1016/j.ejvsvf.2025.01.005","DOIUrl":"10.1016/j.ejvsvf.2025.01.005","url":null,"abstract":"<div><h3>Objective</h3><div>Peri-procedural antithrombotics are used extensively to prevent thromboembolic complications during non-cardiac arterial procedures (NCAP) worldwide. However, there is a lack of evidence to support recommendations on antithrombotic strategies, possibly leading to substantial variation in local practices. A comprehensive overview of antithrombotic strategies is needed to identify the most widely accepted protocols employed during NCAP, highlight variations in local practices, and identify new research targets to establish evidence based peri-procedural anticoagulation management.</div></div><div><h3>Methods</h3><div>An international, web based survey study was conducted from March to October 2023, targeting vascular clinical specialists who applied antithrombotic strategies during NCAP in daily practice.</div></div><div><h3>Results</h3><div>The survey was completed by 436 vascular clinical specialists from 45 countries (Europeans: 93%, vascular surgeons or vascular surgery residents: 98%). Systemic unfractionated heparin was used by nearly all vascular specialists during all procedures (varying between 98–99%, depending on the procedure type), but could vary depending on specific NCAP. A fixed starting dose (39–52%, most often 5 000 IU [80–89%]) or an actual bodyweight dependent dose (42–52%, most commonly 100 IU/kg [40–67%] or 50 IU/kg [17–40%]) was mainly used. Except during fenestrated or branched endovascular aneurysm repair procedures (51%), activated clotting time (ACT) was employed by a minority (26–31%). A large variety in measurement protocols was observed, yet a target ACT of 200 seconds was most often used for all NCAP types (44–54%). Most vascular specialists considered a heparin follow up dose (61–81%) and heparin reversal using protamine (54–63%), both for a variety of indications. Of the participants, 68% expressed discontent with their current antithrombotic protocol(s).</div></div><div><h3>Conclusion</h3><div>This comprehensive, international survey study revealed large variation among vascular clinical specialists’ heparinisation strategies during NCAP. Together with the considerable discontent expressed regarding protocols, this emphasises the urgent need for comparative, randomised studies on antithrombotic management during NCAP.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 8-15"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endovascular Repair of a Subclavian Artery Aneurysm With Re-purposed Aorto-Iliac Stent Graft Components 血管内修复锁骨下动脉瘤的主动脉-髂支架移植组件

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.05.001

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Nobuyoshi Kawaharada

Introduction

Subclavian artery aneurysms (SAAs) are rare, and reports on their treatment remain limited.

Report

An 83 year old male patient who had undergone endovascular aortic repair (EVAR) for an abdominal aortic aneurysm two years previously was referred to the institution for endovascular treatment of a SAA which he preferred over open surgery. Endovascular repair was undertaken under general anaesthesia and open, access of the right axillary artery with introduction of a 14 F guide sheath; subsequently a 23 × 16 × 100 mm limb graft (Gore Excluder, WL Gore and Associates, Flagstaff, USA) was deployed distally with an additional 23 × 23 × 33 mm proximal cuff (Excluder) with successful SAA exclusion.

Discussion

A case of endovascular treatment for a right subclavian artery aneurysm is reported. A successful stent graft from the abdominal EVAR device portfolio was successfully employed.

锁骨下动脉瘤（SAAs）是罕见的，其治疗的报道仍然有限。报告一名83岁男性患者两年前接受了血管内主动脉修复术（EVAR）治疗腹主动脉瘤，他更喜欢SAA的血管内治疗，而不是开放手术。血管内修复是在全身麻醉下进行的，并在引入14f引导鞘的情况下开放了右腋窝动脉；随后，将23 × 16 × 100 mm肢体移植物（Gore Excluder, WL Gore and Associates, Flagstaff， USA）与另一个23 × 23 × 33 mm近端袖带（Excluder）一起置于远端，成功排除SAA。本文报告一例右锁骨下动脉瘤的血管内治疗。从腹部EVAR装置组合中成功移植了支架。

引用次数: 0

Overexpression of αVβ3 Integrin in an Aortic Aneurysm Murine Model: Confirmation in Ex Vivo Human Abdominal Aortic Aneurysm Tissue and Its Potential Application for Molecular Imaging Characterisation αVβ3整合素在小鼠主动脉瘤模型中的过表达：在离体人腹主动脉瘤组织中的证实及其在分子影像学表征中的潜在应用

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.08.003

Javier E. Anaya-Ayala , Brenda J. Galicia-Vega , Jacqueline Mejía-Cervantes , Ezequiel Solano-Mendivil , Ingrid A. Landero-Aguilar , Brenda Marquina-Castillo , Carlos Bravo-Reyna , Carlos Serrano-Gavuzzo , Luis A. Medina-Velázquez , Carlos A. Hinojosa

Background

The pathophysiological mechanisms that occur in the wall of aortic aneurysms are not fully understood. Angiogenesis is a characteristic change in aneurysmal disease; αVβ3 integrin is a glycoprotein overexpressed in this biological process. This study aimed to evaluate angiogenic activity in a murine model of thoracic aortic aneurysm (TAA) using molecular imaging and immunofluorescence, and to assess differences in αVβ3 integrin expression in ex vivo human aneurysmal and non-diseased aortic tissues.

Methods

Eight Wistar rats underwent experimental induction of TAA with peri-adventitial calcium chloride (CaCl2) and were evaluated with micropositron emission tomography (MicroPET) using arginine-glycine-aspartate with gallium 68 (⁶⁸Ga-RGD) as a radiotracer. The Wilcoxon test was used to compare the chemically induced site (aneurysm) and intact aortic tissue (control). Six months later, the specimens were euthanised and tissues were evaluated with immunofluorescence. For human aorta analysis, diseased and non-diseased arterial portions were obtained from 13 patients (mean age 67 years, 85% males) who underwent open abdominal aortic aneurysm repair and were evaluated with the same protocol as the experimental specimens.

Results

An overall MicroPET uptake was obtained in the murine models; the median standard uptake value of ⁶⁸Ga-RGD in the aneurysm was 0.0125, while the uptake in controls was 0.0003 (p = 0.011). Immunofluorescence confirmed overexpression of integrin αVβ3 in the aneurysm wall in comparison with the control tissue (p < 001). Human aneurysmal samples also had a statistically significant overexpression of αVβ3 (p = 0.031).

Conclusions

Significant differences in the angiogenic process were demonstrated with molecular imaging and immunofluorescence in the murine TAA model. Differences in αVβ3 integrin expression were confirmed when comparing diseased and non-diseased aortas in humans.

背景：发生在主动脉瘤壁的病理生理机制尚不完全清楚。血管生成是动脉瘤疾病的特征性改变；αVβ3整合素是在这一生物过程中过表达的糖蛋白。本研究旨在利用分子成像和免疫荧光技术评价小鼠胸主动脉瘤（TAA）模型的血管生成活性，并评估αVβ3整合素在离体人动脉瘤组织和非病变主动脉组织中的表达差异。方法采用周外氯化钙（CaCl2）诱导8只Wistar大鼠TAA，以精氨酸-甘氨酸-天冬氨酸-镓68 （68Ga-RGD）为示踪剂，采用微正电子发射断层扫描（MicroPET）对其进行评价。采用Wilcoxon检验比较化学诱导部位（动脉瘤）和完整主动脉组织（对照组）。6个月后，对标本实施安乐死，并用免疫荧光法对组织进行评估。对于人主动脉分析，从13例（平均年龄67岁，85%男性）接受腹主动脉瘤切开修复的患者（平均年龄67岁，85%男性）获得病变和非病变动脉部分，并采用与实验标本相同的方案进行评估。结果小鼠模型获得了全鼠微pet摄取；动脉瘤组68Ga-RGD标准摄取值中位数为0.0125，对照组为0.0003 （p = 0.011）。免疫荧光证实，与对照组织相比，整合素αVβ3在动脉瘤壁上过表达（p < 001）。人动脉瘤样品αVβ3过表达也有统计学意义（p = 0.031）。结论分子成像和免疫荧光显示小鼠TAA模型在血管生成过程中存在显著差异。αVβ3整合素在人病变和非病变主动脉中的表达差异得到证实。

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引用次数: 0

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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