EJVES Vascular Forum最新文献

英文中文

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

Artificial Intelligence (AI) in Imaging Characterisation: Universality and Availability Will Rule Them All 人工智能（AI）在成像表征：普遍性和可用性将统治他们

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.08.001

Eduardo Arrea Salto , Marion Carrier

引用次数: 0

Open Repair of Isolated Internal Iliac Artery Aneurysm in a Young Patient With Loeys–Dietz Syndrome 开放性修复年轻Loeys-Dietz综合征患者孤立的髂内动脉瘤

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.04.006

Ezra Y. Koh , Dianna M. Milewicz , Thanila A. Macedo , Gustavo S. Oderich

Introduction

Isolated internal iliac artery aneurysms in the absence of aorto-iliac disease are exceedingly rare. The case of a 41 year old woman who presented after experiencing several weeks of lower abdominal pain is reported. She was diagnosed with a large, isolated right internal iliac artery aneurysm.

Report

Patient medical records were reviewed retrospectively. The patient underwent genetic evaluation, after which she was diagnosed with Loeys–Dietz syndrome type I. Given her age and heritable aortic disease, her aneurysm was treated by open surgical repair via a right retroperitoneal approach with an interposition bypass graft. The patient's hospital course was uneventful, and she was discharged home in good condition.

Discussion

This report demonstrates an open surgical technique to treat an isolated iliac aneurysm in a patient with underlying heritable vascular disease.

在没有主动脉-髂疾病的情况下，孤立的髂内动脉瘤是非常罕见的。病例41岁的妇女谁提出后经历几个星期的下腹部疼痛报告。她被诊断为一个巨大的，孤立的右髂内动脉动脉瘤。回顾性回顾了患者的医疗记录。患者接受了基因评估，之后被诊断为Loeys-Dietz综合征i型。考虑到她的年龄和遗传性主动脉疾病，她的动脉瘤通过右腹膜后入路和间置旁路移植术进行开放手术修复。病人的住院过程平安无事，出院时情况良好。本报告展示了一种开放性手术技术来治疗患有遗传性血管疾病的孤立髂动脉瘤患者。

引用次数: 0

Long Term Follow Up of Abdominal Aortic Aneurysms Treated With Endovascular Aneurysm Sealing (EVAS) and Endovascular Aneurysm Repair (EVAR): A Single Centre Retrospective Cohort 经血管内动脉瘤密封（EVAS）和血管内动脉瘤修复（EVAR）治疗的腹主动脉瘤的长期随访：单中心回顾性队列

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.05.003

Simen Tveten Berge , Konstantin Valerievitch Naletov , Sven Ross Mathisen

Objective

The Nellix endovascular aneurysm sealing (EVAS) system demonstrated promising short and midterm outcomes following its introduction in 2011. However, long term results have shown a high incidence of graft failure. This study aimed to compare the long term outcomes of EVAS compared with standard endovascular aneurysm repair (EVAR).

Methods

This single centre, retrospective, comparative cohort analysis used prospectively registered data from an internal quality control registry at Innlandet Hospital Trust, Hamar Hospital, Norway. Two hundred and eighty-one patients underwent elective endovascular repair for aorto-iliac aneurysm disease between 2013 – 2016. Primary elective EVAR (n = 164) was compared with primary elective EVAS (n = 117).

Results

Technical success was achieved in 100% of the EVAR and EVAS cases. The EVAS patients had a shorter hospital stay (3.7 vs. 4.7 days; p = 0.008), and lower post-procedural C reactive protein (CRP) levels (p < 0.001). No statistically significant differences were found in 30 day (p = 0.79), one year (p = 0.97), or long term all cause mortality rates, with a median follow up of 9.3 years (p = 0.93). During long term follow up, type II endoleaks were significantly less common in EVAS patients (2.6% vs. 32.3%; p < 0.001). However, EVAS had lower device durability, with freedom from device failure at five years of 54% compared with 98% for EVAR (p < 0.001). Open surgical conversion was required in 31% of EVAS patients and 2.4% of EVAR patients (p < 0.001). Aneurysm sac growth ≥5 mm was recorded in 47% of EVAS cases compared with 17.1% of EVAR cases (p < 0.001).

Conclusion

While long term all cause mortality was comparable between EVAS and EVAR, EVAS was associated with statistically significantly higher rates of graft failure, aneurysm sac growth, aneurysm related death, and open surgical conversion. Close monitoring of new prosthetic devices in registries is essential to identify early signs of device failure.

目的Nellix血管内动脉瘤密封（EVAS）系统自2011年推出以来，显示出良好的短期和中期疗效。然而，长期结果显示移植物衰竭的发生率很高。本研究旨在比较EVAS与标准血管内动脉瘤修复（EVAR）的长期结果。方法本研究采用挪威Hamar医院innlanddet医院信托内部质量控制登记处的前瞻性注册数据，采用单中心、回顾性、比较队列分析。2013 - 2016年间，231例患者接受了主动脉-髂动脉瘤疾病的选择性血管内修复。主要选择性EVAR （n = 164）与主要选择性EVAS （n = 117）进行比较。结果EVAR和EVAS的技术成功率为100%。EVAS患者住院时间较短(3.7天vs. 4.7天；p = 0.008)，术后C反应蛋白（CRP）水平较低(p <；0.001)。30天（p = 0.79）、1年（p = 0.97）或长期全因死亡率均无统计学差异，中位随访时间为9.3年（p = 0.93）。在长期随访中，II型内漏在EVAS患者中明显较少见(2.6% vs. 32.3%；p & lt;0.001)。然而，EVAS的设备耐久性较低，五年内设备无故障率为54%，而EVAR为98% (p <；0.001)。31%的EVAS患者和2.4%的EVAR患者需要进行开放手术转换(p <；0.001)。动脉瘤囊≥5mm的EVAS病例占47%，EVAR病例占17.1% (p <；0.001)。结论：虽然EVAS和EVAR的长期全因死亡率相当，但EVAS与移植失败、动脉瘤囊生长、动脉瘤相关死亡和开放手术转换的发生率有统计学意义上的显著升高。在登记处密切监测新的假体装置对于识别设备故障的早期迹象至关重要。

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引用次数: 0

Acknowledgement of Reviewers 审稿人致谢

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/S2666-688X(25)00089-9

引用次数: 0

Coil Migration: From Ruptured Aortic Pseudoaneurysm to Bronchus 线圈迁移：从破裂的主动脉假性动脉瘤到支气管

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.07.001

Hao Liu , Zhihui Dong , Weiguo Fu

Introduction

Coil migration is an extremely infrequent finding after aneurysm coil embolisation. This case report presents a rare complication of a ruptured tuberculous aortic pseudoaneurysm that was managed by an endoscopic technique.

Report

A patient presented with a ruptured tuberculous aortic arch pseudoaneurysm after receiving an emergency endovascular repair and aneurysm embolisation. After eight months, the patient returned with the sensation of a foreign body in the larynx. Computed tomography angiography (CTA) showed coil migration from the aneurysmal sac to the bronchus, trachea, and larynx, with bronchoscopy confirming the finding. Most coils within the respiratory system were disintegrated by Q switched neodymium-yttrium aluminium garnet laser and hook scissors and then removed. The patient's symptoms were relieved and follow up CTA showed no more migrated coils.

Discussion

This case highlights that coil embolisation should be employed with extreme caution, or even avoided in mycotic aortic aneurysms, particularly when ruptured, given the potential consequences. A rigorous and consistent follow up protocol is essential to monitor the aneurysm for changes and to detect any complications related to the coils, particularly in the presence of a pre-existing “channel”. Endoscopic techniques could be used as treatment methods for coil migration.

动脉瘤圈栓塞后，动脉瘤圈移位是一种极为罕见的发现。本病例报告提出了一个罕见的并发症的破裂结核性主动脉假性动脉瘤是由内窥镜技术管理。报告一例患者在接受紧急血管内修复和动脉瘤栓塞治疗后出现结核性主动脉弓假性动脉瘤破裂。八个月后，病人回来时感觉喉部有异物。计算机断层血管造影（CTA）显示线圈从动脉瘤囊迁移到支气管、气管和喉部，支气管镜检查证实了这一发现。呼吸系统内的大多数线圈被Q开关钕钇铝石榴石激光和钩剪分解，然后移除。患者的症状得到缓解，后续CTA显示没有更多的线圈迁移。本病例强调，考虑到潜在的后果，在真菌性主动脉瘤中，尤其是在破裂时，应非常谨慎地使用线圈栓塞，甚至避免使用。严格和一致的随访方案对于监测动脉瘤的变化和检测与线圈相关的任何并发症至关重要，特别是在存在预先存在的“通道”的情况下。内镜技术可作为线圈移位的治疗方法。

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引用次数: 0

Trends in Management and Outcomes of Blunt Thoracic Aortic Injury in the United States 美国钝性胸主动脉损伤的治疗趋势和结果

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum

Pub Date : 2025-01-01 DOI: 10.1016/j.ejvsvf.2025.07.004

Anne-Sophie C. Romijn , Vinamr Rastogi , Patrick D. Conroy , Yuchen Liu , Sai Divya Yadavalli , Lars Stangenberg , Vincent Jongkind , Noelle N. Saillant , Hence J.M. Verhagen , Marc L. Schermerhorn

Objective

Blunt thoracic aortic injury (BTAI) is a significant cause of mortality and morbidity in the United States. The diagnosis and treatment of BTAI has evolved over the last few decades. This study aimed to examine the incidence and outcomes of thoracic endovascular aortic repair (TEVAR), non-operative management (NOM), and open aortic repair (OAR) for BTAI over a 14 year period.

Methods

Patients with BTAI from the National Inpatient Sample between 2006 – 2019 were studied and compared within three time periods: 2006–2010, 2011–2015, and 2016–2019. Waldtest and Pearson's chi-squared were performed to test whether management, patient characteristics, and in hospital mortality changed over time.

Results

An estimate of 8 175 BTAI patients was identified, with an increasing estimate from 375 patients in 2006 to 750 patients in 2019. TEVAR utilisation increased from 17% to 37% during the study period, while those who received OAR and NOM decreased (OAR 16%–1.3%; NOM 67%–61%). There was an increasing trend in patients treated in an urban teaching hospital (2006–2010 vs. 2016–2019: 88% vs. 95%; p trend <0.001), and more patients were transferred from another hospital (12% vs. 18%; p trend = 0.027). Over the years, patients who received NOM were older (45 vs. 50 years; p < 0.001) and had more concurrent injuries, while the mortality rate among this group did not change (adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.42–1.02; p = 0.060) Patients who received TEVAR were also older over the years (41 years vs. 46 years; p < 0.001), but they had fewer concurrent injuries, and the mortality rate remained stable (aOR 0.97, 95% CI 0.33–2.88; p = 0.96).

Conclusion

The estimated number of patients with BTAI was twice as large in 2019 compared with 2006, and the use of TEVAR increased, largely replacing OAR.

目的在美国，钝性胸主动脉损伤（BTAI）是导致死亡率和发病率的重要原因。在过去的几十年里，BTAI的诊断和治疗不断发展。本研究旨在研究14年期间胸椎血管内主动脉修复（TEVAR）、非手术治疗（NOM）和主动脉开放修复（OAR）治疗BTAI的发生率和结果。方法对2006 - 2019年全国住院患者样本中的BTAI患者进行研究，并在2006 - 2010年、2011-2015年和2016-2019年三个时间段进行比较。采用Waldtest和Pearson卡方检验来检验管理、患者特征和住院死亡率是否随时间变化。结果估计有8175例BTAI患者被确定，从2006年的375例增加到2019年的750例。在研究期间，TEVAR的利用率从17%增加到37%，而接受OAR和NOM的患者则下降（OAR 16%-1.3%; NOM 67%-61%）。在城市教学医院就诊的患者呈上升趋势（2006-2010年vs. 2016-2019年：88% vs. 95%； p趋势<；0.001），更多的患者从其他医院转过来（12% vs. 18%； p趋势= 0.027）。多年来,病人接受以前的老(45 vs . 50年;p & lt; 0.001)和有更多的并发损伤,而这一组死亡率没有变化(调整优势比(aOR)为0.65,95%可信区间[CI] 0.42 -1.02; p = 0.060)病人TEVAR也老多年来(41年和46年;p & lt; 0.001),但并发损伤更少,死亡率保持稳定(优势比0.97,95%可信区间0.33 - -2.88;p = 0.96)。结论2019年BTAI患者估计数量是2006年的两倍，TEVAR的使用增加，在很大程度上取代了OAR。

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引用次数: 0

Re: Sartorius and Gracilis Muscle Flaps as Adjuncts to 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.2025.08.007

Prajnasini Satapathy, Rachana Mehta, Ranjana Sah

引用次数: 0

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