Journal of Vascular Surgery Cases Innovations and Techniques最新文献

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Comparing neurological complications between endovascular and open surgical repair of the descending thoracic aorta 胸降主动脉血管内修复术与开放修复术神经系统并发症的比较

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-08 DOI: 10.1016/j.jvscit.2025.102086

Raiyan Talukder BS , Kristina Montez BS , Zain Moin BS , Ahmed Abdou MS , Brianna Whithorn DO , Dimitry Sayenko MD, PhD , Amir Faraji MD, PhD , Maham Rahimi MD, PhD

Background

Diseases of the descending thoracic aorta (DTA) can require endovascular, open, or a hybrid repair. Endovascular repair involves the minimally invasive placement of a stent graft, whereas open repair requires a thoracotomy to replace tissue with a graft. This study aims to compare the neurological morbidity associated with endovascular vs open repair of the DTA, and specifically for unruptured DTA aneurysm and DTA dissection.

Methods

We utilized TriNetX, a deidentified patient database to query adult patients with endovascular and open repair of DTA disease, unruptured aneurysm, and dissection. Propensity score matching was conducted for age, sex, and several comorbidities including tobacco use, diabetes mellitus, chronic kidney disease, hypertension, and connective tissue disorders. We studied ischemic stroke, intracranial hemorrhage, spinal cord ischemia, and mortality at 30 days and 1, 5, and 10 years postoperatively. χ² analyses and odds ratios were calculated for each cohort at each time point.

Results

After propensity matching, we studied 3229 patients for repair for DTA disease, 116 for unruptured descending thoracic aortic aneurysm, and 126 for descending thoracic aortic dissection. We find that endovascular repair of the DTA is associated with a lower likelihood of stroke at all time points and spinal cord ischemia and mortality within 30 days of surgery. At 5 and 10 years, patients with open procedures have a lower likelihood of all-cause mortality. No significant difference in odds were observed for patients with aneurysms or dissections.

Conclusions

Patients undergoing repair of the descending thoracic aorta should be monitored closely intraoperatively and postoperatively for neurological events to allow for early rescue maneuvers and interventions to reduce overall morbidity and complication rates.

背景：胸降主动脉（DTA）疾病可能需要血管内、开放或混合修复。血管内修复包括微创支架植入，而开放式修复需要开胸手术用移植物代替组织。本研究旨在比较血管内与开放式DTA修复相关的神经系统疾病，特别是未破裂的DTA动脉瘤和DTA夹层。方法：我们使用TriNetX（一个未识别的患者数据库）查询血管内和开放修复DTA疾病、未破裂动脉瘤和夹层的成人患者。对年龄、性别和一些合并症（包括吸烟、糖尿病、慢性肾病、高血压和结缔组织疾病）进行倾向评分匹配。我们研究了缺血性中风、颅内出血、脊髓缺血和术后30天、1年、5年和10年的死亡率。在每个时间点对每个队列进行χ2分析和优势比计算。结果经过倾向匹配后，我们研究了3229例DTA疾病修复患者，116例未破裂的胸降主动脉动脉瘤患者，126例胸降主动脉夹层患者。我们发现，DTA的血管内修复与卒中在所有时间点、脊髓缺血和手术后30天内死亡率的降低有关。在5岁和10岁时，接受开放式手术的患者全因死亡率较低。动脉瘤或夹层患者的几率无显著差异。结论行胸降主动脉修复术的患者应在术中及术后密切监测神经系统事件，以便及早采取抢救措施和干预措施，降低总体发病率和并发症发生率。

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引用次数: 0

Traumatic superior mesenteric artery pseudoaneurysm complicated by high-output arteriovenous fistula 外伤性肠系膜上动脉假性动脉瘤并发高输出量动静脉瘘

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-08 DOI: 10.1016/j.jvscit.2025.102082

Yaqub Ahmedfiqi BS , Michael Chaney MD , Nicholas Stevens DO , Chidambaram Nachiappan BS , Saad Shebrain MD , Sheldon Maltz MD

Mesenteric pseudoaneurysms are uncommon vascular lesions most often resulting from trauma, iatrogenic injury, or local inflammation. Arteriovenous fistula formation following pseudoaneurysm development is a reported but exceedingly rare complication. Herein presented is the case of a 57-year-old male who sustained multiple injuries in a high-speed motor vehicle collision and was found to have a pseudoaneurysm of the superior mesenteric artery, further complicated by arteriovenous fistula formation. This presented clinically as persistent atrial fibrillation with rapid ventricular response, high output heart failure, and hemodynamic instability. This was repaired in an open fashion, resulting in immediate cardiac stabilization and an overall favorable outcome for the patient.

肠系膜假性动脉瘤是一种罕见的血管病变，通常由创伤、医源性损伤或局部炎症引起。假性动脉瘤发展后的动静脉瘘形成是一种报道但极为罕见的并发症。本文报告一名57岁男性，在高速机动车碰撞中多处受伤，发现肠系膜上动脉假性动脉瘤，并进一步并发动静脉瘘形成。这在临床上表现为持续性心房颤动伴快速心室反应、高输出心力衰竭和血流动力学不稳定。这是一个开放的方式修复，导致立即心脏稳定和患者的总体有利的结果。

引用次数: 0

Thoracoabdominal multibranch endograft repair of type Ia endoleak after laser in situ fenestration and chimney endovascular repair for pararenal aortic aneurysm 激光原位开窗烟囱血管内修复术治疗肾旁主动脉瘤后胸腹多支腔内修复术

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-06 DOI: 10.1016/j.jvscit.2025.102087

Samuel Nofsinger MA , Anne Marker BA , Uttara Nag MD , Steven Cheung MD , Todd R. Vogel MD , Jonathan Bath MD

Failure after endovascular aneurysm repair (EVAR) often presents unique challenges in terms of definitive repair and is often associated with more extensive coverage of the descending thoracic aorta combined with a solution for the visceral aortic branches. Failure after a fenestrated or branched EVAR presents an even greater technical challenge and often requires conversion to open explantation and thoracoabdominal repair. We present a case of a 64-year-old woman who failed EVAR owing to aortic neck dilatation leading to symptomatic type Ia endoleak and underwent laser in situ fenestrated endograft repair with bilateral renal chimney stenting. Owing to aneurysm sac expansion and continued type Ia endoleak, she consented to urgent thoracoabdominal multibranched endoprosthesis with left iliac branched endoprosthesis for definitive repair. The patient consented to publication of this case report.

血管内动脉瘤修复失败（EVAR）通常在最终修复方面具有独特的挑战，并且通常与更广泛的胸降主动脉覆盖以及内脏主动脉分支的解决方案相关。开窗或分支EVAR后的失败带来了更大的技术挑战，通常需要转换为开放外植体和胸腹修复。我们报告了一例64岁的女性，由于主动脉颈部扩张导致症状性Ia型内漏而导致EVAR失败，并接受了激光原位开窗内移植修复双侧肾烟囱支架。由于动脉瘤囊扩张和持续的Ia型内漏，她同意紧急胸腹多支假体联合左髂支假体进行最终修复。病人同意发表这份病例报告。

引用次数: 0

PRKG1 pathogenic variants cause thoracic aortic dissection with minimal aortic dilation: Insights from the UTHealth Houston multidisciplinary aortic and vascular disease conference PRKG1致病性变异导致胸主动脉夹层并伴有最小的主动脉扩张：来自UTHealth休斯顿多学科主动脉和血管疾病会议的见解

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-06 DOI: 10.1016/j.jvscit.2025.102088

Ali Askari BSA , Jennifer R. Landes MEd , Alana Cecchi MS, CGC , Cihan Duran MD , Bihong Zhao MD, PhD , Gustavo S. Oderich MD , L. Maximilian Buja MD , Dianna M. Milewicz MD, PhD , Anthony L. Estrera MD , Rana O. Afifi MD , Siddharth K. Prakash MD, PhD

A single, recurrent, gain-of-function pathogenic variant in PRKG1 (p.Arg177Gln, also referred to as p.Arg192Gln) causes heritable thoracic aortic disease with a high lifetime risk for aortic dissections that frequently occur before there is enlargement of the proximal thoracic aorta. This report summarizes the clinical manifestations of the PRKG1 pathogenic variant in two unrelated families, including early-onset type A dissection, chronic thoracoabdominal dissection with visceral complications, and elective aortic repair of the proximal aorta with minimal enlargement. In both families, multiple individuals experienced acute dissections at young ages that led to five fatalities. These cases illustrate the early onset of manifestations of PRKG1-related disease, which are primarily dissections, and underscore the essential role of aggressive gene-based management to prevent dissection in these cases.

PRKG1中一种单一的、复发的、功能获得性致病性变异（p.a g177gln，也称为p.a g192gln）可导致遗传性胸主动脉疾病，其终生主动脉夹层风险高，通常发生在胸近端主动脉扩大之前。本报告总结了PRKG1致病变异在两个不相关家族的临床表现，包括早发性A型夹层、慢性胸腹夹层合并内脏并发症、选择性主动脉修复近端主动脉并小扩张。在这两个家庭中，许多人在年轻时经历了急性解剖，导致5人死亡。这些病例说明了prkg1相关疾病的早期表现，主要是解剖，并强调了在这些病例中积极的基于基因的管理以防止解剖的重要作用。

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引用次数: 0

Multiple arterial aneurysms involving the thoracoabdominal aorta and renal arteries in a young patient with possible heritable etiology: Two-stage open surgical repair management 累及胸腹主动脉和肾动脉的多发动脉瘤的年轻患者，可能的遗传病因：两期开放手术修复管理

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-06 DOI: 10.1016/j.jvscit.2025.102084

Annarita Santoro MD , Marian Broasca MD , Horatiu Moldovan MD , Fiorenza De Lisio MD , Francesca Sanvito MD , Germano Melissano MD

Multilevel arterial aneurysm refers to aneurysms in multiple sites, such as the aorta, cerebral, or peripheral arteries, often caused by atherosclerosis, heritable thoracic aortic disease, inflammation, or infection. We report the case of a 48-year-old patient with multilevel arterial aneurysm managed with staged open surgical repair. The first surgery addressed an 11-cm abdominal aortic aneurysm and renal artery aneurysms, followed by thoracoabdominal aortic aneurysm repair. Both procedures were uneventful, with successful grafting and preserved organ perfusion. Six-month follow-up computed tomography scan showed no complications. Postoperative genetic testing revealed two variants of uncertain significance (PKD1, FBN1). Open surgical repair proved safe and effective in a high-volume center.

多层动脉动脉瘤是指发生在主动脉、脑动脉或外周动脉等多个部位的动脉瘤，通常由动脉粥样硬化、遗传性胸主动脉疾病、炎症或感染引起。我们报告一例48岁的多节段动脉瘤患者，采用分阶段开放手术修复。第一次手术处理了一个11厘米的腹主动脉瘤和肾动脉动脉瘤，随后进行了胸腹主动脉瘤修复。两种手术都很顺利，移植成功，器官灌注得以保存。6个月随访计算机断层扫描未见并发症。术后基因检测显示两个不确定意义的变异（PKD1, FBN1）。开放性手术修复在大容量中心被证明是安全有效的。

引用次数: 0

Explant of an infected aortic arch fenestrated stent graft with extra-anatomic reconstruction 带解剖外重建的感染主动脉弓开窗支架外植体

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-06 DOI: 10.1016/j.jvscit.2025.102085

Ezra Y. Koh MD, Akiko Tanaka MD, PhD, Naveed U. Saqib MD, Anthony L. Estrera MD

Fenestrated and branched endovascular aortic repair has increasingly been implemented to treat aortic arch pathology. Infection of these endografts is a rare complication—and one that has not yet been described for fenestrated and branched endovascular aortic repair of the arch. We present a 61-year-old man who presented with an infection of a fenestrated arch endograft secondary to an aortoesophageal fistula. He underwent staged surgical treatment using extra-anatomic bypasses. His postoperative course was complicated by prolonged hypoxemic respiratory failure and the development of end-stage renal disease. The patient was readmitted and died 93 days postoperatively because of surgical complications.

开窗和分支血管内主动脉修复术越来越多地应用于治疗主动脉弓病变。这些血管内移植物的感染是一种罕见的并发症，并且尚未有关于开窗和分支血管内主动脉弓修复的报道。我们提出了一个61岁的男子谁提出了感染的开窗弓内移植物继发于主动脉食管瘘。他接受了分阶段的解剖外旁路手术治疗。他的术后过程因长期低氧性呼吸衰竭和终末期肾脏疾病的发展而复杂化。患者再次入院，术后93天因手术并发症死亡。

引用次数: 0

Carotid endarterectomy remains a feasible bailout for progressive disease after transcarotid artery revascularization: A case report 颈动脉内膜切除术仍然是经颈动脉重建术后进行性疾病的可行救助：一个病例报告

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-06 DOI: 10.1016/j.jvscit.2025.102079

Aidin Baghbani MD, Blaz Podgorsek MD, Jason B. Storch MD, Gordon H. Martin MD, Naveed U. Saqib MD, Daniel G. Miles MD

Carotid endarterectomy (CEA) remains the gold standard for carotid revascularization, though transcarotid artery revascularization (TCAR) has emerged as a less invasive alternative. We present a 67-year-old man with prior bilateral TCAR who developed severe right internal carotid artery restenosis 14 months after the procedure. Imaging confirmed >80% stenosis due to progressive plaque burden compressing the stent. The patient underwent successful CEA with en bloc stent explant using a standard technique. Recovery was uneventful. This case demonstrates the technical feasibility and safety of surgical stent explant after TCAR and reinforces CEA as a reliable salvage strategy when stent failure or disease progression occurs.

颈动脉内膜切除术（CEA）仍然是颈动脉血运重建术的金标准，尽管经颈动脉血运重建术（TCAR）已成为一种侵入性较小的替代方法。我们报告了一位67岁的男性患者，他之前患有双侧TCAR，在手术后14个月发生了严重的右颈内动脉再狭窄。影像学证实80%的狭窄是由于斑块累进压迫支架所致。患者采用标准技术成功行CEA整块支架植入术。恢复过程平淡无奇。该病例证明了TCAR后手术支架植入术的技术可行性和安全性，并强化了CEA作为支架失效或疾病进展时可靠的挽救策略。

引用次数: 0

Surgical triumph over mycotic threat: Managing a superior mesenteric artery aneurysm complicated by endocarditis 手术战胜真菌威胁：处理肠系膜上动脉瘤并发心内膜炎

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-01 DOI: 10.1016/j.jvscit.2025.102073

Victor Cabrera-Bou MD , Alyssa Dellutri BS , Frederick Fisher MD , Adel Hanandeh MD , Giancarlo Cires MD

Mycotic aneurysms of the superior mesenteric artery (SMA) are rare (<1% of mesenteric aneurysms) and often linked to infective endocarditis, carrying high rupture and mortality risks. We report a 53-year-old man with prior mitral and aortic valve replacement for Streptococcus mutans endocarditis, found incidentally to have a 2.1-cm saccular SMA aneurysm on computed tomography angiography. Given its infected appearance and complex branching, open resection with reversed saphenous vein interposition graft was performed. Recovery was uneventful. This case highlights early recognition, imaging, and the role of open repair in infected, anatomically challenging SMA aneurysms.

肠系膜上动脉（SMA）的霉菌性动脉瘤是罕见的（占肠系膜动脉瘤的1%），通常与感染性心内膜炎有关，具有很高的破裂和死亡风险。我们报告一名53岁男性，先前因变形链球菌心内膜炎而行二尖瓣和主动脉瓣置换术，在计算机断层血管造影中偶然发现一个2.1厘米的囊状SMA动脉瘤。鉴于其感染的外观和复杂的分支，开放切除与反向隐静脉间置移植物。恢复过程平淡无奇。本病例强调了早期识别、影像学检查和开放性修复在感染的、解剖上具有挑战性的SMA动脉瘤中的作用。

引用次数: 0

A case of intravascular leiomyomatosis with intracardiac extension 血管内平滑肌瘤病伴心内扩张1例

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-12-01 DOI: 10.1016/j.jvscit.2025.102076

Crystal Jin-Yang Sia MBBS, Jack Kian Ch'ng FRCS

Intravascular leiomyomatosis is a rare, histologically benign tumor that exhibits clinically aggressive behavior owing to its unique tendency to spread through the venous system resulting in life-threatening complications. Although complete surgical resection remains the cornerstone of treatment, it presents significant technical and perioperative challenges. This paper aims to outline key considerations essential for achieving a safe and complete resection.

血管内平滑肌瘤病是一种罕见的组织学良性肿瘤，由于其独特的倾向，通过静脉系统扩散，导致危及生命的并发症，表现出临床侵袭性行为。虽然完全手术切除仍然是治疗的基石，但它提出了重大的技术和围手术期挑战。本文旨在概述实现安全和完全切除的关键考虑因素。

引用次数: 0

Pseudoaneurysm formation in the setting of segmental arterial mediolysis with arterial embolization and angioplasty 假性动脉瘤在动脉栓塞和血管成形术的节段性动脉中形成

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques

Pub Date : 2025-11-28 DOI: 10.1016/j.jvscit.2025.102070

Courtney Brown BS , Kendall Stalls BS , Rowdy Fitzpatrick BS , Carmen Piccolo III DO

Segmental arterial mediolysis (SAM) is a rare, noninflammatory disease process that leads to disruption of the arterial media. As the disease develops, it can lead to vascular aneurysm and dissection. This case follows a 39-year-old woman presenting with epigastric abdominal pain secondary to SAM and consequent pseudoaneurysm formation in the celiac artery. In this case, surgical intervention was a beneficial treatment when paired with antiplatelet therapy. Further documentation of SAM is necessary to broaden understanding of proper endovascular therapy and create adequate treatment protocols to improve patient outcomes.

节段性动脉介质溶解（SAM）是一种罕见的非炎症性疾病，可导致动脉介质的破坏。随着疾病的发展，它会导致血管动脉瘤和夹层。本病例是一名39岁的女性，表现为腹腔动脉假性动脉瘤形成后继发于SAM的上腹部疼痛。在这种情况下，手术干预配合抗血小板治疗是一种有益的治疗方法。有必要进一步记录SAM，以扩大对适当血管内治疗的理解，并制定适当的治疗方案，以改善患者的预后。

引用次数: 0

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Journal of Vascular Surgery Cases Innovations and Techniques

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