EJVES Vascular Forum最新文献

{"title":"Coil Migration: From Ruptured Aortic Pseudoaneurysm to Bronchus","authors":"Hao Liu ,&nbsp;Zhihui Dong ,&nbsp;Weiguo Fu","doi":"10.1016/j.ejvsvf.2025.07.001","DOIUrl":"10.1016/j.ejvsvf.2025.07.001","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Report</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 124-127"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265205","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}

{"title":"Trends in Management and Outcomes of Blunt Thoracic Aortic Injury in the United States","authors":"Anne-Sophie C. Romijn ,&nbsp;Vinamr Rastogi ,&nbsp;Patrick D. Conroy ,&nbsp;Yuchen Liu ,&nbsp;Sai Divya Yadavalli ,&nbsp;Lars Stangenberg ,&nbsp;Vincent Jongkind ,&nbsp;Noelle N. Saillant ,&nbsp;Hence J.M. Verhagen ,&nbsp;Marc L. Schermerhorn","doi":"10.1016/j.ejvsvf.2025.07.004","DOIUrl":"10.1016/j.ejvsvf.2025.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>vs</em>. 2016–2019: 88% <em>vs</em>. 95%; <em>p</em> trend &lt;0.001), and more patients were transferred from another hospital (12% vs. 18%; <em>p</em> trend = 0.027). Over the years, patients who received NOM were older (45 <em>vs</em>. 50 years; <em>p</em> &lt; 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; <em>p</em> = 0.060) Patients who received TEVAR were also older over the years (41 years <em>vs</em>. 46 years; <em>p</em> &lt; 0.001), but they had fewer concurrent injuries, and the mortality rate remained stable (aOR 0.97, 95% CI 0.33–2.88; <em>p</em> = 0.96).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 128-140"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265192","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}

{"title":"Re: Sartorius and Gracilis Muscle Flaps as Adjuncts to the Management of Complicated Femoral Wounds in Vascular Surgery","authors":"Prajnasini Satapathy,&nbsp;Rachana Mehta,&nbsp;Ranjana Sah","doi":"10.1016/j.ejvsvf.2025.08.007","DOIUrl":"10.1016/j.ejvsvf.2025.08.007","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Page 208"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690183","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}

{"title":"Successful Coil Embolisation With Isolation Technique of Ulnar Artery Aneurysm in Hypothenar Hammer Syndrome: A Case Report","authors":"Hiroshi Yukimoto ,&nbsp;Takayuki Miyauchi ,&nbsp;Takashi Nakamura","doi":"10.1016/j.ejvsvf.2025.04.002","DOIUrl":"10.1016/j.ejvsvf.2025.04.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypothenar hammer syndrome is a rare vascular condition characterised by ulnar artery damage, which can manifest as thrombosis or aneurysm formation. While surgical treatment has been the mainstay of therapy, endovascular treatment may offer a minimally invasive alternative. Reports of successful coil embolisation of ulnar artery aneurysms in hypothenar hammer syndrome are extremely limited in the literature.</div></div><div><h3>Report</h3><div>A woman in her sixties with a history of smoking and atrial fibrillation on anticoagulants presented with a one month history of a painful pulsatile mass in her dominant right hypothenar eminence. Imaging revealed a 15 mm ulnar artery aneurysm with corkscrew deformity characteristic of hypothenar hammer syndrome. Digital subtraction angiography demonstrated adequate collateral circulation through palmar arches during selective compression tests. Endovascular coil embolisation using isolation technique was performed via the ipsilateral brachial artery access under axillary nerve block. A triple coaxial system was used to deploy detachable coils for aneurysm isolation. The procedure achieved complete aneurysm occlusion while maintaining adequate blood flow to all digits through collateral circulation from the radial artery via the palmar arch. Three month follow up contrast enhanced magnetic resonance imaging demonstrated complete resolution of the ulnar artery aneurysm with no evidence of ischaemic complications.</div></div><div><h3>Discussion</h3><div>Pre-procedural confirmation of adequate collateral circulation is essential for endovascular treatment, which can provide effective minimally invasive treatment for ulnar artery aneurysm in hypothenar hammer syndrome without leaving a palmar surgical scar. While the initial results are promising, careful patient selection and longer follow up are needed to establish the durability of this treatment approach.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 57-61"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589282","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}

{"title":"Post-Implantation Syndrome Incidence After Secondary Endovascular Aortic Interventions","authors":"Tiago F. Ribeiro ,&nbsp;Rita Soares Ferreira ,&nbsp;Carlos Amaral ,&nbsp;Frederico Bastos Gonçalves ,&nbsp;Maria Emília Ferreira","doi":"10.1016/j.ejvsvf.2025.02.005","DOIUrl":"10.1016/j.ejvsvf.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>Post-implantation syndrome (PIS), a systemic inflammatory response following endovascular aneurysm repair (EVAR) is estimated to occur in approximately 30% of patients. It has been hypothesised to resemble a hypersensitivity reaction. A secondary exposure after a priming event could result in an altered risk and severity of PIS. This study aimed to determine the incidence and short-term clinical consequences of PIS after secondary endovascular aortic aneurysm interventions.</div></div><div><h3>Methods</h3><div>Single centre retrospective observational study. Between 2011 and 2022, all consecutive patients who underwent secondary elective endovascular aortic interventions following a primary elective EVAR, thoracic endovascular aneurysm repair, or fenestrated and branched EVAR were considered. Re-interventions occurring within the first 30 post-operative days were excluded. PIS was defined as tympanic temperature ≥38°C and C-reactive protein (CRP) &gt; 75 mg/L. Primary outcome was PIS incidence within three days. Secondary outcomes were short-term (30 days) outcomes and risk factors for PIS. Logistic regression analysis was performed to correct for confounders.</div></div><div><h3>Results</h3><div>Seventy nine secondary interventions in 71 patients who underwent elective primary repair were analysed. During secondary repair, shorter stent graft combinations (median 305 <em>vs.</em> 171 mm, <em>p</em> ≤ 0.001) were implanted. In addition, patients were older (70 <em>vs.</em> 73 years, <em>p</em> = 0.043) and more frequently taking statin (79.4 <em>vs.</em> 92.2%, <em>p</em> = 0.026) or antiplatelet agents (66.7 <em>vs.</em> 85.6 %, <em>p</em> = 0.010). Overall, PIS occurred in 24.0%, significantly lower following secondary repair (32.3% <em>vs.</em> 16.5%, <em>p</em> = 0.022, adjusted odds ratio 0.38, 95% confidence interval 0.16–0.89). There were no significant differences in highest recorded temperature (<em>p</em> = 0.25), days of fever (<em>p</em> = 0.44), CRP, or peak white blood cell count. CRP presented a more delayed elevation in secondary PIS.</div></div><div><h3>Conclusion</h3><div>After secondary endovascular aortic interventions, PIS incidence appears reduced compared with primary aortic repair. This should be interpreted with caution, in the context of procedural heterogeneity and limited number of cases. Further studies to confirm these findings and explore the underlying immunological mechanisms are required.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 34-41"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523660","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}

{"title":"Post-Implantation Syndromes After Endovascular Aneurysm Repair: Not Good, But Not Bad Either","authors":"Andrés Reyes Valdivia","doi":"10.1016/j.ejvsvf.2025.04.001","DOIUrl":"10.1016/j.ejvsvf.2025.04.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 32-33"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523661","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}

{"title":"Indocyanine Green Fluorescence Angiography to Assess Tissue Perfusion Before Common Femoral Artery Aneurysm Ligation After Transfemoral Amputation","authors":"Steven J.G. Leeuwerke ,&nbsp;Harry G.M. Vaassen ,&nbsp;Robbert Meerwaldt","doi":"10.1016/j.ejvsvf.2025.01.003","DOIUrl":"10.1016/j.ejvsvf.2025.01.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The superiority of indocyanine green fluorescence angiography (ICG-FA) to the clinical eye alone to assess tissue perfusion has been demonstrated in various surgical fields. This short report demonstrates the <em>in vivo</em> use of ICG-FA to assess skin perfusion before ligating the external iliac artery (EIA) to exclude a common femoral artery (CFA) aneurysm.</div></div><div><h3>Report</h3><div>A 70-year-old man presented with a CFA aneurysm after a previous transfemoral amputation. Ligation of the EIA was proposed, but concerns about tissue perfusion warranted a careful approach. The CFA was exposed using an infra-inguinal incision. Intra-operative ICG inflow and washout patterns were semi-quantitatively analysed to assess dermal perfusion of the femoral stump before and after EIA clamping. Based on similar patterns, distal EIA ligation was performed without ischaemic complications.</div></div><div><h3>Conclusion</h3><div>Indocyanine green fluorescence angiography is a promising technique for <em>in vivo</em> assessment of tissue perfusion in peripheral arterial disease, but standardised protocols for perfusion quantification are required to more accurately predict tissue viability.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 41-44"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445674","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}

{"title":"Recovery of EndoAnchors Using a Four Loop Vascular Retriever Snare: Adaptive Solutions for Adverse Events Related to Endovascular Material","authors":"Clara Raventós,&nbsp;Fabricio Barahona,&nbsp;Vicente Riambau","doi":"10.1016/j.ejvsvf.2025.05.004","DOIUrl":"10.1016/j.ejvsvf.2025.05.004","url":null,"abstract":"<div><h3>Introduction</h3><div>EndoAnchors are adjuncts used for the prevention and treatment of type I endoleak and graft migration in thoracic or abdominal endovascular aortic aneurysm repair in patients with a challenging aortic neck. They secure the stent graft mechanically to the aortic wall by means of metallic screws. Adverse events are infrequent; however, the most common ones are fracture and or dislodgment (0.3–0.9%) and applicator malfunction (0.3%), as observed in this case.</div></div><div><h3>Case</h3><div>A 77 year old woman showed symptoms of increasing interscapular chest pain for three months. A computed tomography angiography scan revealed a large and symptomatic ascending thoracic aortic aneurysm with extension to the arch and descending thoracic aorta. The patient was operated on urgently using a frozen elephant trunk technique, with pain cessation. The residual thoracic aneurysm was repaired six months later with two overlapped thoracic endografts placed 15 mm above the celiac trunk and distal EndoAnchors, an off label use, due to a severely angulated distal landing zone. During the seventh and last EndoAnchor deployment on an angulated surface, a malfunction of its applicator was detected, which caused EndoAnchor detachment and migration, flying into the aorta's lumen and landing close to the aortic wall below the graft. It was then trapped with a CloverSnare four loop vascular retriever (CookMedical, Bloomington, IL, USA), supported by an 8.5 F TourGuide steerable sheath. During extraction, it fractured into two pieces at the common iliac artery. The previous manoeuvre was repeated at this level, recovering the fractured piece. Final completion angiography showed a good result without endoleak. The immediate post-operative and follow up scans were uneventful.</div></div><div><h3>Conclusion</h3><div>EndoAnchor detachment is uncommon but when it does occur, it is a solvable issue and can be retrieved using a snare and extracted with the proper endovascular tools and expertise.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 66-70"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653435","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}

{"title":"Preservation of One Anterior and One Posterior Internal Iliac Artery Branch in a Case of Bilateral Common and Internal Iliac Arterial Aneurysms","authors":"Anna Stene Hurtsén ,&nbsp;Artai Pirouzram ,&nbsp;Tal Hörer","doi":"10.1016/j.ejvsvf.2025.05.009","DOIUrl":"10.1016/j.ejvsvf.2025.05.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Endovascular treatment of iliac aneurysms with sparing of the internal iliac arterial circulation is feasible with iliac branch devices. However, insufficient distal seal with the endovascular devices on the market can be challenging. In this case, the anatomy was complex due to the extent of the aneurysms, and the available technical options were limited.</div></div><div><h3>Report</h3><div>A 65 year old man with aneurysms in the left common iliac (43 mm) and bilateral internal iliac arteries (right 41 mm; left 49 mm) was treated with an aortobi-iliac stent graft and bilateral iliac branch devices with extensions to opposing anterior (right) and posterior (left) branches of the internal iliac artery through staged interventions. At six weeks of follow up all treated aneurysms had decreased or were stable in size. Clinical signs of right sided gluteal claudication were evident at six weeks of follow up but no symptoms remained 20 weeks post-operatively.</div></div><div><h3>Discussion</h3><div>The presented case illustrates a technique to preserve pelvic circulation in a case of bilateral common and internal iliac arterial aneurysms. Extensions of the internal iliac limb of the iliac branch device, into the opposing anterior and posterior divisions of the internal iliac artery, may offer a strategy to reduce pelvic ischaemia in scenarios where the anatomy limits the use of standard iliac branch devices.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 71-74"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679696","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}

{"title":"Bottom up Treatment for Vulvar and Lower Extremity Varicose Veins of Pelvic Origin: A Case Report","authors":"Aleksandra Jaworucka-Kaczorowska ,&nbsp;Marianne De Maeseneer","doi":"10.1016/j.ejvsvf.2024.12.004","DOIUrl":"10.1016/j.ejvsvf.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Extrapelvic varices of pelvic origin, such as vulvar varices, and lower extremity varicose veins (VVs) of pelvic origin are being diagnosed with increasing frequency. A proper management strategy, including history, physical examination, duplex ultrasound (DUS) of the lower extremities, DUS of pelvic escape points, selection of appropriate treatment, and post-treatment care, is essential for good patient outcomes and satisfaction.</div></div><div><h3>Case report</h3><div>A non-pregnant, 27 year old female presented with prominent vulvar varices in combination with right sided VVs on the anterior and medial thigh, calf, and buttock. She was successfully managed by bottom up treatment with ultrasound guided foam sclerotherapy. The bottom up technique involves treatment of VVs of pelvic origin by direct puncture of the pelvic escape points and associated VVs, without embolisation of the pelvic veins.</div></div><div><h3>Conclusion</h3><div>This case illustrates successful bottom up treatment in accordance with recent guidelines in a female patient with extensive VVs of pelvic origin.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 53-56"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610200","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}