Pub Date : 2025-01-01Epub Date: 2025-02-21DOI: 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.
{"title":"Ultrasound Guided Needle Penetration Technique for Recanalisation of Short Segment Chronic Femoral Vein Occlusion","authors":"Tamás Büki, Vasileios Leivaditis, Manfred Dahm","doi":"10.1016/j.ejvsvf.2025.02.004","DOIUrl":"10.1016/j.ejvsvf.2025.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Case report</h3><div>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.</div></div><div><h3>Conclusion</h3><div>This case highlights the feasibility and benefits of ultrasound guided needle penetration as an alternative recanalisation approach in severe scarring peripheral chronic venous occlusion.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 61-64"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-02-04DOI: 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.
{"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}
Pub Date : 2025-01-01Epub Date: 2025-08-21DOI: 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.
{"title":"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","authors":"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","doi":"10.1016/j.ejvsvf.2025.08.003","DOIUrl":"10.1016/j.ejvsvf.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>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 <em>ex vivo</em> human aneurysmal and non-diseased aortic tissues.</div></div><div><h3>Methods</h3><div>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 (<sup>68</sup>Ga-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.</div></div><div><h3>Results</h3><div>An overall MicroPET uptake was obtained in the murine models; the median standard uptake value of <sup>68</sup>Ga-RGD in the aneurysm was 0.0125, while the uptake in controls was 0.0003 (<em>p</em> = 0.011). Immunofluorescence confirmed overexpression of integrin αVβ3 in the aneurysm wall in comparison with the control tissue (<em>p</em> < 001). Human aneurysmal samples also had a statistically significant overexpression of αVβ3 (<em>p</em> = 0.031).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 117-123"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265193","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}
Pub Date : 2025-01-01Epub Date: 2025-02-21DOI: 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.
{"title":"Aortic Intimal Invagination and Septectomy Following Electrosurgical Septotomy in a Patient With a Type B Dissection","authors":"Cecilie Markvard Møller, Steen Fjord Pedersen, Jacob Budtz-Lilly","doi":"10.1016/j.ejvsvf.2025.02.003","DOIUrl":"10.1016/j.ejvsvf.2025.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Case report</h3><div>This case report describes an important complication of electrosurgical septotomy causing aortic intimal invagination in a patient with a type B aortic dissection.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 57-60"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"Endovascular Repair of a Subclavian Artery Aneurysm With Re-purposed Aorto-Iliac Stent Graft Components","authors":"Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Nobuyoshi Kawaharada","doi":"10.1016/j.ejvsvf.2025.05.001","DOIUrl":"10.1016/j.ejvsvf.2025.05.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Subclavian artery aneurysms (SAAs) are rare, and reports on their treatment remain limited.</div></div><div><h3>Report</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 62-65"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604351","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}
Pub Date : 2025-01-01Epub Date: 2025-09-15DOI: 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.
{"title":"Defying the Clock: Restoring Renal Function After 72 Hours of Subacute Renal Thrombosis","authors":"Roberto Cunha , Nuno Coelho , Alexandra Canedo","doi":"10.1016/j.ejvsvf.2025.09.004","DOIUrl":"10.1016/j.ejvsvf.2025.09.004","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Report</h3><div>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 m<sup>2</sup>. At the six month follow up, there were no recurrent symptoms, and laboratory results showed eGFR >90 mL/min/1.73 m<sup>2</sup>.</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 174-177"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332436","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}
Pub Date : 2025-01-01Epub Date: 2025-10-14DOI: 10.1016/j.ejvsvf.2025.10.001
Ruth A. Benson
{"title":"A Global Survey of Follow Up Imaging After EVAR Reminds Us That We Are Still Speaking Different Languages","authors":"Ruth A. Benson","doi":"10.1016/j.ejvsvf.2025.10.001","DOIUrl":"10.1016/j.ejvsvf.2025.10.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 197-198"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473770","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}
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。
{"title":"Reasons for Delayed Carotid Endarterectomy for Symptomatic Carotid Stenosis in Norway 2018–2019: A National Audit","authors":"Martin Altreuther , Celine Harlinn Sørlie , Benedicte Skaug Hansen , Christian Lyng , Karsten Myhre , Toril Rabben , Ramez Bahar , Tonje Berglund , Dorte Bundgaard , Erik Mulder Pettersen","doi":"10.1016/j.ejvsvf.2025.07.003","DOIUrl":"10.1016/j.ejvsvf.2025.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>Symptomatic carotid stenosis is one of the main causes of <em>amaurosis fugax</em>, 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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 78-82"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863992","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}
Pub Date : 2025-01-01Epub Date: 2025-06-16DOI: 10.1016/j.ejvsvf.2025.06.001
Salomé Kuntz , Nabil Chakfe
{"title":"Towards an Off the Shelf Multibranch Device for Endovascular Aortic Arch Repair?","authors":"Salomé Kuntz , Nabil Chakfe","doi":"10.1016/j.ejvsvf.2025.06.001","DOIUrl":"10.1016/j.ejvsvf.2025.06.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 101-102"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007687","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}
Pub Date : 2025-01-01Epub Date: 2025-09-20DOI: 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.
{"title":"A Physician Made Biological Stent Graft for the Replacement of a Left Renal Vein Leiomyosarcoma","authors":"Francesca Maria Feroldi , Bruno Gargiulo , Magali Fau , Xavier Berard","doi":"10.1016/j.ejvsvf.2025.09.006","DOIUrl":"10.1016/j.ejvsvf.2025.09.006","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Technique</h3><div>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 <em>en bloc</em> 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.</div></div><div><h3>Discussion</h3><div>Complete surgical excision remains the cornerstone of vein sarcoma treatment and offers the best chance for disease control. The literature has only reported <em>en bloc</em> 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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 183-185"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361543","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}
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