Pub Date : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.10.002
Oumaima Aouam , Carolijn J.M. de Bresser , Eline S. van Hattum , W. Marnix de Fijter , Hidde Jongsma , Patrick W.H.E. Vriens , Vincent van Weel , Gert J. de Borst
Objective
Free floating thrombus in the carotid artery (cFFT) is a rare and poorly understood condition with an unclear definition and diagnostic criteria. This systematic review aimed to propose a reporting standard to ensure diagnostic consistency and a universal definition of cFFT.
Methods
PubMed and EMBASE were systematically searched from inception until 01 May 2025, using terms including “free floating thrombus” and “carotid”, along with imaging modalities. Eligibility criteria included studies on patients with cFFT, diagnosed through well defined imaging criteria. Two authors independently screened eligible literature and extracted data. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) score. The composite endpoint was the radiological description of cFFT per imaging modality.
Results
A systematic search identified 611 publications, from which 20 were included. These studies were predominantly of low quality, with a mean MINORS score of 9 for non-comparative and 16 for comparative studies. These 20 studies identified 17 distinct imaging based descriptions of cFFT. The descriptions were derived from five different imaging modalities, encompassing both static and dynamic imaging. Computed tomography angiography (CTA) was the most reported modality, followed by duplex ultrasound (DUS). On CTA, cFFT is diagnosed as a thrombus with circumferential flow, proximal attachment to the vessel wall, and extending distally in the lumen. On DUS, cFFT is diagnosed by circumferential flow, attachment to the arterial wall, and synchronous movement with the cardiac cycle.
Conclusion
The published literature lacks high quality studies. It is suggested that the diagnosis of cFFT requires static imaging, preferably with CTA. If static imaging is inconclusive, a dedicated dynamic assessment by DUS, performed by an experienced sonographer, is suggested. The proposed definition aims to standardise the diagnostic workflow for cFFT, thereby ensuring consistent interpretation and unified terminology across research and clinical practice, which should also enhance individual patient data meta-analyses on cFFT in the future.
目的颈动脉游离漂浮血栓(cFFT)是一种罕见的疾病,其定义和诊断标准尚不明确。本系统综述旨在提出一个报告标准,以确保诊断一致性和cFFT的通用定义。方法系统检索spubmed和EMBASE自成立至2025年5月1日,检索术语包括“游离漂浮血栓”和“颈动脉”,以及成像方式。入选标准包括通过明确的影像学标准诊断的cFFT患者。两位作者独立筛选符合条件的文献并提取数据。采用非随机研究方法学指数(Methodological Index for non - random Studies,未成年人)评分评估研究质量。复合终点是cFFT每一种成像方式的放射学描述。结果系统检索到文献611篇,纳入文献20篇。这些研究主要是低质量的,非比较研究的平均未成年人得分为9,比较研究的平均未成年人得分为16。这20项研究确定了17种不同的基于图像的cFFT描述。这些描述来自五种不同的成像方式,包括静态和动态成像。计算机断层血管造影(CTA)是报道最多的方式,其次是双工超声(DUS)。在CTA上,cFFT被诊断为圆周流动的血栓,近端附着于血管壁,并在管腔中向远端延伸。在DUS上,cFFT通过周向血流、与动脉壁的附着以及与心脏周期的同步运动来诊断。结论已发表文献缺乏高质量的研究。提示cFFT的诊断需要静态成像,最好是CTA。如果静态成像不确定,建议由经验丰富的超声医师进行DUS的专门动态评估。该定义旨在标准化cFFT的诊断工作流程,从而确保在研究和临床实践中保持一致的解释和统一的术语,这也将在未来加强对cFFT的个体患者数据荟萃分析。
{"title":"Definition of Carotid Artery Free Floating Thrombus: A Systematic Review and Call for Standardisation of Imaging and Nomenclature","authors":"Oumaima Aouam , Carolijn J.M. de Bresser , Eline S. van Hattum , W. Marnix de Fijter , Hidde Jongsma , Patrick W.H.E. Vriens , Vincent van Weel , Gert J. de Borst","doi":"10.1016/j.ejvsvf.2025.10.002","DOIUrl":"10.1016/j.ejvsvf.2025.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>Free floating thrombus in the carotid artery (cFFT) is a rare and poorly understood condition with an unclear definition and diagnostic criteria. This systematic review aimed to propose a reporting standard to ensure diagnostic consistency and a universal definition of cFFT.</div></div><div><h3>Methods</h3><div>PubMed and EMBASE were systematically searched from inception until 01 May 2025, using terms including “free floating thrombus” and “carotid”, along with imaging modalities. Eligibility criteria included studies on patients with cFFT, diagnosed through well defined imaging criteria. Two authors independently screened eligible literature and extracted data. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) score. The composite endpoint was the radiological description of cFFT per imaging modality.</div></div><div><h3>Results</h3><div>A systematic search identified 611 publications, from which 20 were included. These studies were predominantly of low quality, with a mean MINORS score of 9 for non-comparative and 16 for comparative studies. These 20 studies identified 17 distinct imaging based descriptions of cFFT. The descriptions were derived from five different imaging modalities, encompassing both static and dynamic imaging. Computed tomography angiography (CTA) was the most reported modality, followed by duplex ultrasound (DUS). On CTA, cFFT is diagnosed as a thrombus with circumferential flow, proximal attachment to the vessel wall, and extending distally in the lumen. On DUS, cFFT is diagnosed by circumferential flow, attachment to the arterial wall, and synchronous movement with the cardiac cycle.</div></div><div><h3>Conclusion</h3><div>The published literature lacks high quality studies. It is suggested that the diagnosis of cFFT requires static imaging, preferably with CTA. If static imaging is inconclusive, a dedicated dynamic assessment by DUS, performed by an experienced sonographer, is suggested. The proposed definition aims to standardise the diagnostic workflow for cFFT, thereby ensuring consistent interpretation and unified terminology across research and clinical practice, which should also enhance individual patient data meta-analyses on cFFT in the future.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 199-207"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575863","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 : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.08.004
Francisco Álvarez Marcos, Oliver T.A. Lyons, Arindam Chaudhuri
{"title":"A Round Up of the Prize Winning Papers From the European Journal of Vascular and Endovascular Surgery 2024","authors":"Francisco Álvarez Marcos, Oliver T.A. Lyons, Arindam Chaudhuri","doi":"10.1016/j.ejvsvf.2025.08.004","DOIUrl":"10.1016/j.ejvsvf.2025.08.004","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 163-165"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332434","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}
Superior mesenteric artery aneurysm (SMAA) is a rare presentation mostly secondary to atherosclerosis, infection, cystic medial dysplasia, collagen vascular disorders, trauma, and arterial dissection. However, inflammatory SMAAs are sometimes idiopathic. The aim of the article is to report the case of an idiopathic inflammatory SMAA and perform a systematic literature review.
Case report
A 61 year old man presented with chronic abdominal pain. Computed tomography angiography showed a typical 65 mm diameter inflammatory abdominal aortic aneurysm and a SMAA with similar signs of wall inflammation. Positron emission tomography computed tomography confirmed the inflammation by active fixation. A full workup including all inflammatory markers was negative, and no cause was found. Treatment consisted of fenestrated endograft implantation. At 11 months, follow up confirmed aneurysm exclusion and patency of the stents and a similar SMAA diameter with some mild remaining inflammation.
Literature review
A systematic review of the MEDLINE and PubMed databases extending from 1979 to 2024 by a combined strategy of Medical Subject Headings terms returned only two publications of idiopathic inflammatory SMAA in two patients. In both cases, the symptoms were abdominal or lower back pain and the diagnosis was made by computed tomography angiography. Treatment was open surgery in one case and medical in the other. Median follow up was 18 months.
Conclusion
Idiopathic inflammatory SMAA is rarely described in the literature. The aetiological assessment including histological data should be exhaustive in order not to miss a differential diagnosis.
{"title":"Idiopathic Inflammatory Superior Mesenteric Artery Aneurysm: Case Report and Systematic Literature Review","authors":"Candice Vallauri , Salomé Kuntz , Anne Lejay , Nabil Chakfé","doi":"10.1016/j.ejvsvf.2025.08.005","DOIUrl":"10.1016/j.ejvsvf.2025.08.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Superior mesenteric artery aneurysm (SMAA) is a rare presentation mostly secondary to atherosclerosis, infection, cystic medial dysplasia, collagen vascular disorders, trauma, and arterial dissection. However, inflammatory SMAAs are sometimes idiopathic. The aim of the article is to report the case of an idiopathic inflammatory SMAA and perform a systematic literature review.</div></div><div><h3>Case report</h3><div>A 61 year old man presented with chronic abdominal pain. Computed tomography angiography showed a typical 65 mm diameter inflammatory abdominal aortic aneurysm and a SMAA with similar signs of wall inflammation. Positron emission tomography computed tomography confirmed the inflammation by active fixation. A full workup including all inflammatory markers was negative, and no cause was found. Treatment consisted of fenestrated endograft implantation. At 11 months, follow up confirmed aneurysm exclusion and patency of the stents and a similar SMAA diameter with some mild remaining inflammation.</div></div><div><h3>Literature review</h3><div>A systematic review of the MEDLINE and PubMed databases extending from 1979 to 2024 by a combined strategy of Medical Subject Headings terms returned only two publications of idiopathic inflammatory SMAA in two patients. In both cases, the symptoms were abdominal or lower back pain and the diagnosis was made by computed tomography angiography. Treatment was open surgery in one case and medical in the other. Median follow up was 18 months.</div></div><div><h3>Conclusion</h3><div>Idiopathic inflammatory SMAA is rarely described in the literature. The aetiological assessment including histological data should be exhaustive in order not to miss a differential diagnosis.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 178-182"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361554","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 : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.01.001
Tania Panettella , Maani Hakimi , Juan Antonio Celi de la Torre
Introduction
Graft infections after open or endovascular repair can be devastating, and their treatment is always challenging. For thoraco-abdominal and abdominal aortic aneurysms, fenestrated and branched endografts are used increasingly. Because of the involved materials and anatomy, infective complications can be even more complex.
Report
One year after double fenestrated endovascular endorepair for a type Ia endoleak after standard endovascular repair, a 77 year old patient developed clinical signs for sepsis at an external clinic. As his clinical situation deteriorated, he was then referred to the centre, where an infection focus search revealed a Staphylococcus aureus bacteraemia, and computed tomography (CT), and fludeoxyglucose positron emission tomography CT showed signs of endograft infection. Trestment by endograft explantation followed, and in situ reconstruction with a composite xeno/biosynthetic graft was performed. Through a median laparotomy, endograft explantation as well as in situ reconstruction were technically successful, and sepsis control was achieved under concomitant anti-infective therapy. After a 48 day hospital stay (22 days in the intensive care unit), the patient was discharged to a rehabilitation clinic. After three months of uneventful follow up, precision dual antibiotic therapy with ciprofloxacin and rifampicin was stopped. Four year follow up confirmed freedom from infection and a properly functioning aortic reconstruction.
Discussion
After fenestrated stent graft procedures, successful late conversion is challenging and is known to correlate with high morbidity and mortality. The present case confirms the feasibility of this approach, even in patients with sepsis, with good results.
{"title":"A Case of Successful Explantation of an Infected Fenestrated Aortic Endograft Using a Composite Xeno/Biosynthetic In Situ Reconstruction","authors":"Tania Panettella , Maani Hakimi , Juan Antonio Celi de la Torre","doi":"10.1016/j.ejvsvf.2025.01.001","DOIUrl":"10.1016/j.ejvsvf.2025.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Graft infections after open or endovascular repair can be devastating, and their treatment is always challenging. For thoraco-abdominal and abdominal aortic aneurysms, fenestrated and branched endografts are used increasingly. Because of the involved materials and anatomy, infective complications can be even more complex.</div></div><div><h3>Report</h3><div>One year after double fenestrated endovascular endorepair for a type Ia endoleak after standard endovascular repair, a 77 year old patient developed clinical signs for sepsis at an external clinic. As his clinical situation deteriorated, he was then referred to the centre, where an infection focus search revealed a <em>Staphylococcus aureus</em> bacteraemia, and computed tomography (CT), and fludeoxyglucose positron emission tomography CT showed signs of endograft infection. Trestment by endograft explantation followed, and <em>in situ</em> reconstruction with a composite xeno/biosynthetic graft was performed. Through a median laparotomy, endograft explantation as well as <em>in situ</em> reconstruction were technically successful, and sepsis control was achieved under concomitant anti-infective therapy. After a 48 day hospital stay (22 days in the intensive care unit), the patient was discharged to a rehabilitation clinic. After three months of uneventful follow up, precision dual antibiotic therapy with ciprofloxacin and rifampicin was stopped. Four year follow up confirmed freedom from infection and a properly functioning aortic reconstruction.</div></div><div><h3>Discussion</h3><div>After fenestrated stent graft procedures, successful late conversion is challenging and is known to correlate with high morbidity and mortality. The present case confirms the feasibility of this approach, even in patients with sepsis, with good results.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 25-29"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422401","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}
Native arteriovenous fistulae (AVF) may fail to achieve adequate blood flow or size for successful cannulation and dialysis. No clear strategy exists concerning the effectiveness of collateral vein ligation (CVL) to improve AVF maturation. The aim of this study was to evaluate the effectiveness of CVL in improving AVF maturation.
Methods
A retrospective study was performed, including all patients who underwent CVL for delayed AVF maturation between January 2023 and December 2023. Combined procedures, such as concomitant venous stenosis angioplasties, were excluded. Evolution of AVF flow after CVL compared with AVF flow before CVL was recorded. The primary endpoint was defined as successful maturation after CVL. The AVF was considered mature when it could be routinely cannulated for the total duration of dialysis, for at least six months.
Results
Median follow up was eleven months (range 6–14 months). CVL allowed successful maturation in five of the six patients, with a median AVF flow increase of 44%. In these five patients, sustained dialysis after CVL was uneventful, without need for any additional interventions.
Conclusion
These results highlight the potential effectiveness of CVL in improving AVF maturation, although larger studies are needed to confirm these findings.
{"title":"Collateral Vein Ligation for Arteriovenous Fistula Maturation: A Pilot Study","authors":"Bogdan Bratu , Bettina Chenesseau , Andreea Luchianov , Salomé Kuntz , Nabil Chakfé , Anne Lejay","doi":"10.1016/j.ejvsvf.2025.03.001","DOIUrl":"10.1016/j.ejvsvf.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Native arteriovenous fistulae (AVF) may fail to achieve adequate blood flow or size for successful cannulation and dialysis. No clear strategy exists concerning the effectiveness of collateral vein ligation (CVL) to improve AVF maturation. The aim of this study was to evaluate the effectiveness of CVL in improving AVF maturation.</div></div><div><h3>Methods</h3><div>A retrospective study was performed, including all patients who underwent CVL for delayed AVF maturation between January 2023 and December 2023. Combined procedures, such as concomitant venous stenosis angioplasties, were excluded. Evolution of AVF flow after CVL compared with AVF flow before CVL was recorded. The primary endpoint was defined as successful maturation after CVL. The AVF was considered mature when it could be routinely cannulated for the total duration of dialysis, for at least six months.</div></div><div><h3>Results</h3><div>Median follow up was eleven months (range 6–14 months). CVL allowed successful maturation in five of the six patients, with a median AVF flow increase of 44%. In these five patients, sustained dialysis after CVL was uneventful, without need for any additional interventions.</div></div><div><h3>Conclusion</h3><div>These results highlight the potential effectiveness of CVL in improving AVF maturation, although larger studies are needed to confirm these findings.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 69-72"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864227","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 : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.02.002
Arindam Chaudhuri, Francisco Alvarez Marcos
{"title":"More Reasons to Submit to the EJVES Vascular Forum: A Look Through 2024 into 2025","authors":"Arindam Chaudhuri, Francisco Alvarez Marcos","doi":"10.1016/j.ejvsvf.2025.02.002","DOIUrl":"10.1016/j.ejvsvf.2025.02.002","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Pages 65-67"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808251","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 : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.02.001
Maria Katsarou
{"title":"“Bottom Up” Treatment for Vulvar and Lower Extremity Varicose Veins of Pelvic Origin: Keeping It Simple and Effective","authors":"Maria Katsarou","doi":"10.1016/j.ejvsvf.2025.02.001","DOIUrl":"10.1016/j.ejvsvf.2025.02.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"63 ","pages":"Page 52"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610201","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 : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.09.005
Nusr Ghamri , Donald Harris , David Lindström , Anastasia Dean
Introduction
Extracranial cerebrovascular disease can cause cerebral ischaemia through embolism or hypoperfusion. Managing cerebral ischaemia in patients with hypoperfusion and multivessel cerebrovascular disease can pose challenges owing to the risks of embolisation and haemodynamic instability, especially when normal embolisation protection techniques and cross clamping are hazardous.
Report
This article presents the case of a 74 year old woman who experienced a peri-operative cardiac arrest during femoropopliteal bypass surgery, secondary to undiagnosed severe left ventricular hypertrophy with dynamic outflow obstruction. Following recovery, she developed recurrent right hemispheric transient ischaemic attacks including left hemiplegia. Imaging revealed mild to moderate bilateral carotid bulb, carotid siphon, and vertebral stenoses, but the most significant lesion was a severe, calcified stenosis of brachiocephalic artery. Given the recent cardiac arrest and multiple levels of the disease, the initial plan was for conservative management. Despite medical management with permissive hypertension, the patient continued to experience transient ischaemic attacks as soon as the systolic pressure dropped below 160 mmHg. This scenario led to a multidisciplinary decision to proceed with brachiocephalic artery stenting. The neurointerventional team recommended avoidance of cross clamping if possible given the severe lesions and lack of intact circle of Willis. The procedure was done under general anaesthesia via open, retrograde right axillary access without carotid cross clamping. The post-operative course was uneventful.
Discussion
This case underscores the importance of procedural planning and a multidisciplinary approach in managing complex cerebrovascular conditions, and that unusual pathologies may need unusual treatment.
{"title":"Cerebral Hypoperfusion Caused by Brachiocephalic Artery Stenosis","authors":"Nusr Ghamri , Donald Harris , David Lindström , Anastasia Dean","doi":"10.1016/j.ejvsvf.2025.09.005","DOIUrl":"10.1016/j.ejvsvf.2025.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Extracranial cerebrovascular disease can cause cerebral ischaemia through embolism or hypoperfusion. Managing cerebral ischaemia in patients with hypoperfusion and multivessel cerebrovascular disease can pose challenges owing to the risks of embolisation and haemodynamic instability, especially when normal embolisation protection techniques and cross clamping are hazardous.</div></div><div><h3>Report</h3><div>This article presents the case of a 74 year old woman who experienced a peri-operative cardiac arrest during femoropopliteal bypass surgery, secondary to undiagnosed severe left ventricular hypertrophy with dynamic outflow obstruction. Following recovery, she developed recurrent right hemispheric transient ischaemic attacks including left hemiplegia. Imaging revealed mild to moderate bilateral carotid bulb, carotid siphon, and vertebral stenoses, but the most significant lesion was a severe, calcified stenosis of brachiocephalic artery. Given the recent cardiac arrest and multiple levels of the disease, the initial plan was for conservative management. Despite medical management with permissive hypertension, the patient continued to experience transient ischaemic attacks as soon as the systolic pressure dropped below 160 mmHg. This scenario led to a multidisciplinary decision to proceed with brachiocephalic artery stenting. The neurointerventional team recommended avoidance of cross clamping if possible given the severe lesions and lack of intact circle of Willis. The procedure was done under general anaesthesia via open, retrograde right axillary access without carotid cross clamping. The post-operative course was uneventful.</div></div><div><h3>Discussion</h3><div>This case underscores the importance of procedural planning and a multidisciplinary approach in managing complex cerebrovascular conditions, and that unusual pathologies may need unusual treatment.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 159-162"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332433","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 : 2025-01-01DOI: 10.1016/j.ejvsvf.2025.05.002
Naotoshi Wada, Tetsuya Nomura, Tetsuya Tatsumi
Introduction
Percutaneous retrieval of foreign bodies (PRFB) requires effective grasping of the foreign body and its safe removal through the sheath, a process that can be challenging. While both single loop and multi loop snare retrieval methods are available, no standard PRFB method has been established to date. This Technical Note proposes a foreign body removal technique using a homemade snare and an introducer sheath with an adjustable diameter haemostatic valve, named the Reliable grAsPing and secure retrieval of Intravascular foreign boDies with a HomemAde sNare and an introducer sheath with adjustable Diameter haemostatic valve (RAPID-HANDLE technique). This method enables safe, reliable, and efficient PRFB.
Report
A 75 year old man underwent subcutaneous infusion port placement in the right subclavian vein for gastric cancer therapy. Eight months later, radiography revealed a retained catheter fragment in the pulmonary artery. Computed tomography confirmed a 10 cm catheter fragment straddling the main trunk of the pulmonary artery. PRFB was performed the same day using a 14 F DrySeal Flex introducer sheath inserted through the right common femoral vein. A 7 F guiding catheter was positioned into the main pulmonary artery trunk and the transected end of the catheter was successfully grasped and retrieved using a homemade snare. The total procedure time was 39 minutes.
Discussion
PRFB was successfully completed with the RAPID-HANDLE technique. It is believed that this approach could serve as a standardised procedure for PRFB and is applicable to other intravascular or intracardiac cases.
经皮异物回收(PRFB)需要有效地抓住异物并通过鞘将其安全取出,这一过程可能具有挑战性。虽然单环和多环圈套检索方法都是可用的,但迄今为止还没有建立标准的PRFB方法。本技术说明提出了一种使用自制诱捕器和带直径可调止血阀的引入套的异物清除技术,命名为“使用自制诱捕器和带直径可调止血阀的引入套的血管内异物可靠抓取和安全取出(RAPID-HANDLE技术)”。该方法实现了安全、可靠、高效的PRFB。报告一名75岁男性患者接受右锁骨下静脉皮下静脉输液治疗胃癌。8个月后,x线摄影显示肺动脉内残留导管碎片。计算机断层扫描证实一个10厘米的导管碎片横跨肺动脉主干。当天使用14 F DrySeal Flex引入鞘通过右股总静脉置入PRFB。将一根7f引导导管置入肺动脉主干,并用自制诱捕器成功抓住导管截断的末端并将其取出。手术总时间39分钟。应用RAPID-HANDLE技术成功完成了prfb。相信该方法可以作为PRFB的标准化手术,并适用于其他血管内或心内病例。
{"title":"RAPID-HANDLE Technique for Catheter Retrieval From the Pulmonary Artery Using a Homemade Snare With Adjustable Loop","authors":"Naotoshi Wada, Tetsuya Nomura, Tetsuya Tatsumi","doi":"10.1016/j.ejvsvf.2025.05.002","DOIUrl":"10.1016/j.ejvsvf.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Percutaneous retrieval of foreign bodies (PRFB) requires effective grasping of the foreign body and its safe removal through the sheath, a process that can be challenging. While both single loop and multi loop snare retrieval methods are available, no standard PRFB method has been established to date. This Technical Note proposes a foreign body removal technique using a homemade snare and an introducer sheath with an adjustable diameter haemostatic valve, named the Reliable grAsPing and secure retrieval of Intravascular foreign boDies with a HomemAde sNare and an introducer sheath with adjustable Diameter haemostatic valve (RAPID-HANDLE technique). This method enables safe, reliable, and efficient PRFB.</div></div><div><h3>Report</h3><div>A 75 year old man underwent subcutaneous infusion port placement in the right subclavian vein for gastric cancer therapy. Eight months later, radiography revealed a retained catheter fragment in the pulmonary artery. Computed tomography confirmed a 10 cm catheter fragment straddling the main trunk of the pulmonary artery. PRFB was performed the same day using a 14 F DrySeal Flex introducer sheath inserted through the right common femoral vein. A 7 F guiding catheter was positioned into the main pulmonary artery trunk and the transected end of the catheter was successfully grasped and retrieved using a homemade snare. The total procedure time was 39 minutes.</div></div><div><h3>Discussion</h3><div>PRFB was successfully completed with the RAPID-HANDLE technique. It is believed that this approach could serve as a standardised procedure for PRFB and is applicable to other intravascular or intracardiac cases.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"64 ","pages":"Pages 3-7"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490985","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 : 2024-01-01DOI: 10.1016/j.ejvsvf.2023.12.002
Theodora van Elk , Louise Maes , Anne van der Meij , Robin Lemmens , Maarten Uyttenboogaart , Gert J. de Borst , Clark J. Zeebregts , Paul J. Nederkoorn
Fifteen to 20% of patients with an acute ischaemic stroke have a tandem lesion defined by the combination of an intracranial large vessel thrombo-embolic occlusion and a high grade stenosis or occlusion of the ipsilateral internal carotid artery. These patients tend to have worse outcomes than patients with isolated intracranial occlusions, with higher rates of disability and death. The introduction of endovascular thrombectomy to treat the intracranial lesion clearly improved the outcome compared with treatment with intravenous thrombolysis alone. However, the best treatment strategy for managing the extracranial carotid artery lesion in patients with tandem lesions remains unknown. Current guidelines recommend carotid endarterectomy for patients with transient ischaemic attack or non-disabling stroke and moderate or severe stenosis of the internal carotid artery, within two weeks of the initial event, to prevent major stroke recurrence and death. Alternatively, the symptomatic carotid artery could be treated by endovascular placement of a stent during endovascular thrombectomy (EVT). This would negate the need for a second procedure, immediately reduce the risk of stroke recurrence, increase patient satisfaction, and could be cost effective. However, the administration of dual antiplatelet therapy could potentially increase the risk of symptomatic intracranial haemorrhage in patients with acute ischaemic stroke. Randomised controlled trials evaluating the efficacy and safety of immediate carotid artery stenting during EVT in acute stroke patients with tandem lesions are currently ongoing and will impact the current guidelines regarding the treatment of patients with acute ischaemic stroke due to these tandem lesions.
{"title":"Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke","authors":"Theodora van Elk , Louise Maes , Anne van der Meij , Robin Lemmens , Maarten Uyttenboogaart , Gert J. de Borst , Clark J. Zeebregts , Paul J. Nederkoorn","doi":"10.1016/j.ejvsvf.2023.12.002","DOIUrl":"10.1016/j.ejvsvf.2023.12.002","url":null,"abstract":"<div><p>Fifteen to 20% of patients with an acute ischaemic stroke have a tandem lesion defined by the combination of an intracranial large vessel thrombo-embolic occlusion and a high grade stenosis or occlusion of the ipsilateral internal carotid artery. These patients tend to have worse outcomes than patients with isolated intracranial occlusions, with higher rates of disability and death. The introduction of endovascular thrombectomy to treat the intracranial lesion clearly improved the outcome compared with treatment with intravenous thrombolysis alone. However, the best treatment strategy for managing the extracranial carotid artery lesion in patients with tandem lesions remains unknown. Current guidelines recommend carotid endarterectomy for patients with transient ischaemic attack or non-disabling stroke and moderate or severe stenosis of the internal carotid artery, within two weeks of the initial event, to prevent major stroke recurrence and death. Alternatively, the symptomatic carotid artery could be treated by endovascular placement of a stent during endovascular thrombectomy (EVT). This would negate the need for a second procedure, immediately reduce the risk of stroke recurrence, increase patient satisfaction, and could be cost effective. However, the administration of dual antiplatelet therapy could potentially increase the risk of symptomatic intracranial haemorrhage in patients with acute ischaemic stroke. Randomised controlled trials evaluating the efficacy and safety of immediate carotid artery stenting during EVT in acute stroke patients with tandem lesions are currently ongoing and will impact the current guidelines regarding the treatment of patients with acute ischaemic stroke due to these tandem lesions.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 31-35"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X23000941/pdfft?md5=769eb62096929f360595d75df811e67a&pid=1-s2.0-S2666688X23000941-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139016765","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}