首页 > 最新文献

Journal of Endovascular Therapy最新文献

英文 中文
Drug-Eluting Stent versus Interwoven Bare-Metal Stent in Clinically Significant Vein-Graft Anastomotic Stenosis of Hemodialysis Arteriovenous Graft.
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-04 DOI: 10.1177/15266028241292468
Keerati Hongsakul, Supawut Khantayanuwong, Jitpreedee Sungsiri, Phurich Janjindamai, Surasit Akkakrisee, Kittipitch Bannangkoon, Sorracha Rookkapan, Ussanee Boonsrirat

Purpose: To date, no direct comparison has been made between the patency rates of drug-eluting stents (DESs) and interwoven stents (IWSs) in addressing hemodialysis access dysfunction. This study aims to directly compare the primary patency rates of DES and IWS in clinically significant vein-graft anastomotic stenosis of arteriovenous grafts (AVGs).

Material and methods: Between January 2015 and October 2022, we enrolled all hemodialysis patients with clinically significant vein-graft anastomotic stenosis of AVGs who presented at our institution. Patient demographics, AVG details, lesion characteristics, and primary patency data for each stent group were systemically recorded. Following this, a Kaplan-Meier analysis of the primary stent patency was performed, with statistical significance set at p<0.05.

Results: A total of 51 patients (19 men and 32 women; mean age=64 years; range=49-79 years) were enrolled. Among them, 16 were treated with DES and 35 were treated with IWS. Notably, the most common stent placement location in each group was the vein-graft anastomosis of the brachioaxillary grafts, and the primary patency rate was monitored over a follow-up period of 24 months. At 6, 12, and 24 months, the primary patency rates for DES vs IWS were 100% vs 62.7%, 91.7% vs 38.8%, and 62.9% vs 21.4%, respectively (p<0.001).

Conclusion: Our findings suggest that DES may be a more effective treatment choice for clinically significant vein-graft anastomotic stenosis in AVGs for hemodialysis access than nondrug-coated IWS.

Clinical impact: Drug-eluting stents (DES) have been widely recognized for their efficacy in reducing reintervention rates in coronary and femoropopliteal pathologies. However, their application in managing failing hemodialysis access remains inadequately explored. This study highlights the promising potential of DES in addressing clinically significant vein-graft anastomotic stenosis in hemodialysis arteriovenous grafts (AVG). DES may represent a viable alternative for mitigating substantial immediate recoil stenosis following balloon angioplasty and for preventing early restenosis at the vein-graft anastomosis of AVG, offering a novel therapeutic avenue for future clinical practice.

{"title":"Drug-Eluting Stent versus Interwoven Bare-Metal Stent in Clinically Significant Vein-Graft Anastomotic Stenosis of Hemodialysis Arteriovenous Graft.","authors":"Keerati Hongsakul, Supawut Khantayanuwong, Jitpreedee Sungsiri, Phurich Janjindamai, Surasit Akkakrisee, Kittipitch Bannangkoon, Sorracha Rookkapan, Ussanee Boonsrirat","doi":"10.1177/15266028241292468","DOIUrl":"https://doi.org/10.1177/15266028241292468","url":null,"abstract":"<p><strong>Purpose: </strong>To date, no direct comparison has been made between the patency rates of drug-eluting stents (DESs) and interwoven stents (IWSs) in addressing hemodialysis access dysfunction. This study aims to directly compare the primary patency rates of DES and IWS in clinically significant vein-graft anastomotic stenosis of arteriovenous grafts (AVGs).</p><p><strong>Material and methods: </strong>Between January 2015 and October 2022, we enrolled all hemodialysis patients with clinically significant vein-graft anastomotic stenosis of AVGs who presented at our institution. Patient demographics, AVG details, lesion characteristics, and primary patency data for each stent group were systemically recorded. Following this, a Kaplan-Meier analysis of the primary stent patency was performed, with statistical significance set at p<0.05.</p><p><strong>Results: </strong>A total of 51 patients (19 men and 32 women; mean age=64 years; range=49-79 years) were enrolled. Among them, 16 were treated with DES and 35 were treated with IWS. Notably, the most common stent placement location in each group was the vein-graft anastomosis of the brachioaxillary grafts, and the primary patency rate was monitored over a follow-up period of 24 months. At 6, 12, and 24 months, the primary patency rates for DES vs IWS were 100% vs 62.7%, 91.7% vs 38.8%, and 62.9% vs 21.4%, respectively (p<0.001).</p><p><strong>Conclusion: </strong>Our findings suggest that DES may be a more effective treatment choice for clinically significant vein-graft anastomotic stenosis in AVGs for hemodialysis access than nondrug-coated IWS.</p><p><strong>Clinical impact: </strong>Drug-eluting stents (DES) have been widely recognized for their efficacy in reducing reintervention rates in coronary and femoropopliteal pathologies. However, their application in managing failing hemodialysis access remains inadequately explored. This study highlights the promising potential of DES in addressing clinically significant vein-graft anastomotic stenosis in hemodialysis arteriovenous grafts (AVG). DES may represent a viable alternative for mitigating substantial immediate recoil stenosis following balloon angioplasty and for preventing early restenosis at the vein-graft anastomosis of AVG, offering a novel therapeutic avenue for future clinical practice.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292468"},"PeriodicalIF":1.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Peripheral Arterial Disease Management: Insights From the SerbVasc Registry.
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-04 DOI: 10.1177/15266028241292470
Slobodan Tanaskovic, Nenad Ilijevski, Lazar Davidovic, Jovan Petrovic, Petar Zekic, Aleksandra Milacic, Aleksandra Vujcic, Andrija Roganovic, David Martinovic, Miroslava Popovic, Bogdan Crnokrak, Vuk Jokovic, Zoran Damnjanovic, Ivan Vukasinovic, Aleksandar Tomic, Radivoje Zoranovic, Igor Koncar

Background: This report contributes to VASCUNET data on treating peripheral artery disease (PAD) in Serbia, addressing sex differences, revascularization types, procedure characteristics, and morbidity and mortality.

Methods: SerbVasc, part of the VASCUNET collaboration, includes vascular procedures from 27 Serbian hospitals. Data from 1681 PAD patients were analyzed, focusing on sex disparities, diabetes prevalence, previous procedures, infection and tissue loss, and morbidity and mortality rates.

Results: Males formed the majority, comprising 1169 (69.5%) of the patients. Men were significantly more often treated open surgically compared to women (77.6% vs 68.0%; p=0.000). Diabetes stood at 40.2% prevalence. Smoking history was noted in 61.9% of patients, predominantly males. Complication rates stood at 7.5%, with diabetic patients more prone to reinterventions and graft restenosis. The in-hospital mortality rate was 1.6%, with significant predictors of mortality including urgent procedures and recent myocardial infarction. The severity of the infection was correlated with diabetes (r=0.250, p=0.000) and previous amputations (r=0.186, p=0.000). Patients undergoing revascularization followed by minor amputations had a significantly lower incidence of major amputation (0.1% vs 2.9%, p=0.000).

Conclusions: SerbVasc data provides a comprehensive overview of PAD management, highlighting the significant impact of diabetes and smoking on disease progression and outcomes.

Clinical impact: This study highlights critical aspects of PAD management in developing countries, emphasizing sex differences, risk factors, and outcomes. Males predominated and are more likely to undergo open surgery. Diabetes and smoking significantly influenc disease progression, with diabetic patients experiencing higher rates of graft restenosis and reinterventions. Urgent procedures and recent myocardial infarctions are key predictors of in-hospital mortality. Combining revascularization with minor amputations reduced major amputation rates. These findings provide valuable data for tailoring treatment strategies, optimizing resource allocation, and improving outcomes for PAD patients, with implications extending beyond Serbia to similar healthcare systems.

{"title":"Peripheral Arterial Disease Management: Insights From the SerbVasc Registry.","authors":"Slobodan Tanaskovic, Nenad Ilijevski, Lazar Davidovic, Jovan Petrovic, Petar Zekic, Aleksandra Milacic, Aleksandra Vujcic, Andrija Roganovic, David Martinovic, Miroslava Popovic, Bogdan Crnokrak, Vuk Jokovic, Zoran Damnjanovic, Ivan Vukasinovic, Aleksandar Tomic, Radivoje Zoranovic, Igor Koncar","doi":"10.1177/15266028241292470","DOIUrl":"https://doi.org/10.1177/15266028241292470","url":null,"abstract":"<p><strong>Background: </strong>This report contributes to VASCUNET data on treating peripheral artery disease (PAD) in Serbia, addressing sex differences, revascularization types, procedure characteristics, and morbidity and mortality.</p><p><strong>Methods: </strong>SerbVasc, part of the VASCUNET collaboration, includes vascular procedures from 27 Serbian hospitals. Data from 1681 PAD patients were analyzed, focusing on sex disparities, diabetes prevalence, previous procedures, infection and tissue loss, and morbidity and mortality rates.</p><p><strong>Results: </strong>Males formed the majority, comprising 1169 (69.5%) of the patients. Men were significantly more often treated open surgically compared to women (77.6% vs 68.0%; p=0.000). Diabetes stood at 40.2% prevalence. Smoking history was noted in 61.9% of patients, predominantly males. Complication rates stood at 7.5%, with diabetic patients more prone to reinterventions and graft restenosis. The in-hospital mortality rate was 1.6%, with significant predictors of mortality including urgent procedures and recent myocardial infarction. The severity of the infection was correlated with diabetes (r=0.250, p=0.000) and previous amputations (r=0.186, p=0.000). Patients undergoing revascularization followed by minor amputations had a significantly lower incidence of major amputation (0.1% vs 2.9%, p=0.000).</p><p><strong>Conclusions: </strong>SerbVasc data provides a comprehensive overview of PAD management, highlighting the significant impact of diabetes and smoking on disease progression and outcomes.</p><p><strong>Clinical impact: </strong>This study highlights critical aspects of PAD management in developing countries, emphasizing sex differences, risk factors, and outcomes. Males predominated and are more likely to undergo open surgery. Diabetes and smoking significantly influenc disease progression, with diabetic patients experiencing higher rates of graft restenosis and reinterventions. Urgent procedures and recent myocardial infarctions are key predictors of in-hospital mortality. Combining revascularization with minor amputations reduced major amputation rates. These findings provide valuable data for tailoring treatment strategies, optimizing resource allocation, and improving outcomes for PAD patients, with implications extending beyond Serbia to similar healthcare systems.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292470"},"PeriodicalIF":1.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-Dimensional Printing to Guide Fenestrated/Branched TEVAR in Triple Aortic Arch Branch Reconstruction With a Curative Effect Analysis. 三维打印引导主动脉弓三支重建中的瓣膜/分枝TEVAR疗效分析。
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-21 DOI: 10.1177/15266028231161244
Dong-Sheng Fu, Yi Jin, Zi-He Zhao, Chao Wang, Ying-Huan Shi, Ming-Jie Zhou, Jing-Xiong Zhao, Chen Liu, Tong Qiao, Chang-Jian Liu, Xiao-Qiang Li, Wen-Dong Li, Zhao Liu

Purpose: To summarize experience with and the efficacy of fenestrated/branched thoracic endovascular repair (F/B-TEVAR) using physician-modified stent-grafts (PMSGs) under 3D printing guidance in triple aortic arch branch reconstruction.

Materials and methods: From February 2018 to April 2022, 14 cases of aortic arch aneurysms and 30 cases of aortic arch dissection (22 acute aortic arch dissection and 8 long-term aortic arch dissection)were treated by F/B-TEVAR in our department, including 34 males and 10 females, with an average age of 59.84 ± 11.72 years. Three aortic arch branches were affected in all patients. A 3D-printed model was made according to computed tomography angiography images and used to guide the fabrication of PMSGs. All patients were followed up.

Results: A total of 132 branches were successfully reconstructed with no case of conversion to open surgery. The average operation time was 4.97 ± 1.40 hours, including a mean 44.05 ± 7.72 minutes for stent-graft customization, the mean postoperative hospitalization duration was 9.91 ± 4.47 days, the average intraoperative blood loss was 480.91 mL (100-2810 mL), and the mean postoperative intensive care unit monitoring duration was 1.02 days (0-5 days). No deaths occurred within 30 days of surgery. Postoperative neurological complications occurred in 1 case (2.3%), and retrograde type A dissection occurred in 1 case (2.3%).

Conclusion: Compared with conventional surgery, triple aortic arch branch reconstruction under the guidance of 3D printing is a minimally invasive treatment method with the advantages of accurate positioning, rapid postoperative recovery, few complications, and reliable short- to mid-term effects.

Clinical impact: At present the PMSG usually depend on imaging data and software calculation. With the guidance of 3D printing technology, image data could be transformed into 3D model, which has improved the accuracy of the positioning of the fenestrations. The diameter reduction technique and the internal mini cuff technique have made a complement to the slimed-down fenestration selection process and the low rate of endoleak. As reproducible study, our results may provide reference for TEVAR in different cases.

目的:总结在3D打印引导下使用医生改良支架移植物(PMSGs)进行主动脉弓三分支重建的开窗/分支胸腔内血管修复(F/B-TEVAR)的经验和疗效:2018年2月至2022年4月,我科采用F/B-TEVAR治疗主动脉弓动脉瘤14例,主动脉弓夹层30例(急性主动脉弓夹层22例,长期主动脉弓夹层8例),其中男性34例,女性10例,平均年龄(59.84±11.72)岁。所有患者均有三个主动脉弓分支受累。根据计算机断层扫描血管造影图像制作了一个 3D 打印模型,用于指导 PMSG 的制作。对所有患者进行了随访:结果:共成功重建了 132 个分支,无一例转为开放手术。平均手术时间为(4.97±1.40)小时,其中支架移植物定制平均时间为(44.05±7.72)分钟,术后平均住院时间为(9.91±4.47)天,术中平均失血量为 480.91 毫升(100-2810 毫升),术后重症监护室平均监护时间为 1.02 天(0-5 天)。术后30天内无死亡病例。1例(2.3%)发生术后神经并发症,1例(2.3%)发生逆行A型夹层:与传统手术相比,3D打印引导下的主动脉弓三支重建术是一种微创治疗方法,具有定位准确、术后恢复快、并发症少、中短期疗效可靠等优点:临床影响:目前,PMSG 通常依赖于影像数据和软件计算。临床影响:目前,PMSG 通常依赖于影像数据和软件计算,而在 3D 打印技术的指导下,影像数据可以转化为 3D 模型,从而提高了瓣膜定位的准确性。直径缩小技术和内迷你袖带技术对纤细化瘘管选择过程和低内漏率起到了补充作用。作为一项可重复的研究,我们的结果可为不同病例的 TEVAR 提供参考。
{"title":"Three-Dimensional Printing to Guide Fenestrated/Branched TEVAR in Triple Aortic Arch Branch Reconstruction With a Curative Effect Analysis.","authors":"Dong-Sheng Fu, Yi Jin, Zi-He Zhao, Chao Wang, Ying-Huan Shi, Ming-Jie Zhou, Jing-Xiong Zhao, Chen Liu, Tong Qiao, Chang-Jian Liu, Xiao-Qiang Li, Wen-Dong Li, Zhao Liu","doi":"10.1177/15266028231161244","DOIUrl":"10.1177/15266028231161244","url":null,"abstract":"<p><strong>Purpose: </strong>To summarize experience with and the efficacy of fenestrated/branched thoracic endovascular repair (F/B-TEVAR) using physician-modified stent-grafts (PMSGs) under 3D printing guidance in triple aortic arch branch reconstruction.</p><p><strong>Materials and methods: </strong>From February 2018 to April 2022, 14 cases of aortic arch aneurysms and 30 cases of aortic arch dissection (22 acute aortic arch dissection and 8 long-term aortic arch dissection)were treated by F/B-TEVAR in our department, including 34 males and 10 females, with an average age of 59.84 ± 11.72 years. Three aortic arch branches were affected in all patients. A 3D-printed model was made according to computed tomography angiography images and used to guide the fabrication of PMSGs. All patients were followed up.</p><p><strong>Results: </strong>A total of 132 branches were successfully reconstructed with no case of conversion to open surgery. The average operation time was 4.97 ± 1.40 hours, including a mean 44.05 ± 7.72 minutes for stent-graft customization, the mean postoperative hospitalization duration was 9.91 ± 4.47 days, the average intraoperative blood loss was 480.91 mL (100-2810 mL), and the mean postoperative intensive care unit monitoring duration was 1.02 days (0-5 days). No deaths occurred within 30 days of surgery. Postoperative neurological complications occurred in 1 case (2.3%), and retrograde type A dissection occurred in 1 case (2.3%).</p><p><strong>Conclusion: </strong>Compared with conventional surgery, triple aortic arch branch reconstruction under the guidance of 3D printing is a minimally invasive treatment method with the advantages of accurate positioning, rapid postoperative recovery, few complications, and reliable short- to mid-term effects.</p><p><strong>Clinical impact: </strong>At present the PMSG usually depend on imaging data and software calculation. With the guidance of 3D printing technology, image data could be transformed into 3D model, which has improved the accuracy of the positioning of the fenestrations. The diameter reduction technique and the internal mini cuff technique have made a complement to the slimed-down fenestration selection process and the low rate of endoleak. As reproducible study, our results may provide reference for TEVAR in different cases.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1088-1097"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9201581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identifying Patients at High Risk for Post-EVAR Aneurysm Sac Growth. 识别 EVAR 术后动脉瘤瘤囊生长的高风险患者。
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-16 DOI: 10.1177/15266028231158302
Laura E Bruijn, Jihene Louhichi, Hugo T C Veger, Jan J Wever, Lukas C van Dijk, Hendrik van Overhagen, Jaap F Hamming, Randolph G S Statius van Eps

Purpose: Post-EVAR (endovascular aneurysm repair) aneurysm sac growth can be seen as therapy failure as it is a risk factor for post-EVAR aneurysm rupture. This study sought to identify preoperative patient predictors for developing post-EVAR aneurysm sac growth.

Material and methods: A systematic review was conducted to select potential predictive preoperative factors for post-EVAR sac growth (including a total of 34.886 patients), which were evaluated by a retrospective single-center analysis of patients undergoing EVAR between 2009 and 2019 (N=247) with pre-EVAR computed tomography scans and at least 1 year follow-up. The primary study outcome was post-EVAR abdominal aortic aneurysm (AAA) sac enlargement (≥5 mm diameter increase). Multivariate Cox regression and Kaplan-Meier survival curves were constructed.

Results: Potential correlative factors for post-EVAR sac growth included in the cohort analysis were age, sex, anticoagulants, antiplatelets, renal insufficiency, anemia, low thrombocyte count, pulmonary comorbidities, aneurysm diameter, neck diameter, neck angle, neck length, configuration of intraluminal thrombus, common iliac artery diameter, the number of patent lumbar arteries, and a patent inferior mesenteric artery. Multivariate analysis showed that infrarenal neck angulation (hazard ratio, 1.014; confidence interval (CI), 1.001-1.026; p=0.034) and the number of patent lumbar arteries (hazard ratio, 1.340; CI, 1.131-1.588; p<0.001) were associated with post-EVAR growth. Difference in estimated freedom from post-EVAR sac growth for patients with ≥4 patent lumbar arteries versus <4 patent lumbar arteries became clear after 2 years: 88.5% versus 100%, respectively (p<0.001). Of note, 31% of the patients (n=51) with ≥4 patent lumbar arteries (n=167) developed post-EVAR sac growth. In our cohort, the median maximum AAA diameter was 57 mm (interquartile range [IQR] = 54-62) and the median postoperative follow-up time was 54 months (IQR = 34-79). In all, 23% (n=57) of the patients suffered from post-EVAR growth. The median time for post-EVAR growth was 37 months (IQR = 24-63). In 46 of the 57 post-EVAR growth cases (81%), an endoleak was observed; 2.4% (n=6) of the patients suffered from post-EVAR rupture. The total mortality in the cohort was 24% (n=60); 4% (n=10) was AAA related.

Conclusions: This study showed that having 4 or more patent lumbar arteries is an important predictive factor for postoperative sac growth in patients undergoing EVAR.

Clinical impact: This study strongly suggests that having 4 or more patent lumbar arteries should be included in preoperative counseling for EVAR, in conjunction to the instructions for use (IFU).

目的:EVAR(血管内动脉瘤修补术)后动脉瘤囊增生可视为治疗失败,因为它是EVAR后动脉瘤破裂的风险因素。本研究旨在确定患者术前预测EVAR术后动脉瘤囊增生的因素:通过对2009年至2019年期间接受EVAR手术的患者(N=247)进行回顾性单中心分析,筛选出EVAR术后动脉瘤囊增生的潜在术前预测因素(共包括34.886名患者),并对其进行评估,这些患者均接受过EVAR术前计算机断层扫描且随访至少1年。主要研究结果是EVAR术后腹主动脉瘤(AAA)瘤囊增大(直径增加≥5毫米)。研究人员构建了多变量 Cox 回归和 Kaplan-Meier 生存曲线:队列分析显示,EVAR术后瘤囊增大的潜在相关因素包括年龄、性别、抗凝药物、抗血小板药物、肾功能不全、贫血、血小板计数低、肺部合并症、动脉瘤直径、瘤颈直径、瘤颈角度、瘤颈长度、腔内血栓结构、髂总动脉直径、通畅的腰动脉数量以及通畅的肠系膜下动脉。多变量分析显示,肾动脉颈下成角(危险比,1.014;置信区间(CI),1.001-1.026;P=0.034)和腰动脉通畅数量(危险比,1.340;CI,1.131-1.588;P结论:本研究表明,在接受 EVAR 的患者中,拥有 4 条或更多的通畅腰动脉是术后囊增长的一个重要预测因素:这项研究强烈建议,在 EVAR 的术前咨询中,应结合使用说明 (IFU) 列出是否有 4 条或更多的通畅腰动脉。
{"title":"Identifying Patients at High Risk for Post-EVAR Aneurysm Sac Growth.","authors":"Laura E Bruijn, Jihene Louhichi, Hugo T C Veger, Jan J Wever, Lukas C van Dijk, Hendrik van Overhagen, Jaap F Hamming, Randolph G S Statius van Eps","doi":"10.1177/15266028231158302","DOIUrl":"10.1177/15266028231158302","url":null,"abstract":"<p><strong>Purpose: </strong>Post-EVAR (endovascular aneurysm repair) aneurysm sac growth can be seen as therapy failure as it is a risk factor for post-EVAR aneurysm rupture. This study sought to identify preoperative patient predictors for developing post-EVAR aneurysm sac growth.</p><p><strong>Material and methods: </strong>A systematic review was conducted to select potential predictive preoperative factors for post-EVAR sac growth (including a total of 34.886 patients), which were evaluated by a retrospective single-center analysis of patients undergoing EVAR between 2009 and 2019 (N=247) with pre-EVAR computed tomography scans and at least 1 year follow-up. The primary study outcome was post-EVAR abdominal aortic aneurysm (AAA) sac enlargement (≥5 mm diameter increase). Multivariate Cox regression and Kaplan-Meier survival curves were constructed.</p><p><strong>Results: </strong>Potential correlative factors for post-EVAR sac growth included in the cohort analysis were age, sex, anticoagulants, antiplatelets, renal insufficiency, anemia, low thrombocyte count, pulmonary comorbidities, aneurysm diameter, neck diameter, neck angle, neck length, configuration of intraluminal thrombus, common iliac artery diameter, the number of patent lumbar arteries, and a patent inferior mesenteric artery. Multivariate analysis showed that infrarenal neck angulation (hazard ratio, 1.014; confidence interval (CI), 1.001-1.026; p=0.034) and the number of patent lumbar arteries (hazard ratio, 1.340; CI, 1.131-1.588; p<0.001) were associated with post-EVAR growth. Difference in estimated freedom from post-EVAR sac growth for patients with ≥4 patent lumbar arteries versus <4 patent lumbar arteries became clear after 2 years: 88.5% versus 100%, respectively (p<0.001). Of note, 31% of the patients (n=51) with ≥4 patent lumbar arteries (n=167) developed post-EVAR sac growth. In our cohort, the median maximum AAA diameter was 57 mm (interquartile range [IQR] = 54-62) and the median postoperative follow-up time was 54 months (IQR = 34-79). In all, 23% (n=57) of the patients suffered from post-EVAR growth. The median time for post-EVAR growth was 37 months (IQR = 24-63). In 46 of the 57 post-EVAR growth cases (81%), an endoleak was observed; 2.4% (n=6) of the patients suffered from post-EVAR rupture. The total mortality in the cohort was 24% (n=60); 4% (n=10) was AAA related.</p><p><strong>Conclusions: </strong>This study showed that having 4 or more patent lumbar arteries is an important predictive factor for postoperative sac growth in patients undergoing EVAR.</p><p><strong>Clinical impact: </strong>This study strongly suggests that having 4 or more patent lumbar arteries should be included in preoperative counseling for EVAR, in conjunction to the instructions for use (IFU).</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1107-1120"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9120864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Technical Feasibility of Renal Artery Embolization on a Transplanted Kidney Due to Intractable Unilateral Hydronephrosis After En Bloc Kidney Transplantation: Case Report. 对移植肾进行肾动脉栓塞的技术可行性:病例报告。
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-25 DOI: 10.1177/15266028231159813
Dong-Hwan Kim, Hyung Sub Park, Young-Heun Shin, Chang Jin Yoon, Taeseung Lee

Introduction: En bloc kidney transplantation (EBKT) is a technique used to transplant pediatric kidneys to adult recipients, but can lead to certain complications seldom found in single-kidney transplantation. We report a case of renal artery embolization after EBKT due to intractable unilateral hydronephrosis and highlight the technical details and challenges of the procedure.

Case: An 18-year-old female with MELAS syndrome underwent EBKT from a 10-month-old male baby. Two months later, the patient developed unilateral hydronephrosis and recurrent urinary tract infections, which was intractable to conventional therapy. Therefore, we underwent embolization of the problematic transplanted left kidney. Owing to the complicated anatomy and multiple angulations, multiple microcatheters, wires and support catheters were needed to select the renal arteries. Repeated procedures were required due to remnant flow from small branches and accessory renal arteries that were not easily visualized by conventional angiography, which were eventually detected by adjunctive use of 3-dimensional rotational angiography.

Conclusions: Selective renal artery embolization after EBKT is challenging due to the short renal artery length and multiple angulations, yet it can still be performed safely and effectively by use of meticulous catheter-wire interactions and adjunctive intraoperative imaging techniques to delineate the precise anatomy of the target arteries.

Clinical impact: Selective renal artery embolization, which is less invasive than nephrectomy, can be considered if the culprit kidney must inevitably be sacrificed in en bloc kidney transplantation.

简介:整体肾移植(EBKT)是一种用于将小儿肾脏移植给成人受者的技术,但可能导致单肾移植手术中很少出现的某些并发症。我们报告了一例因难治性单侧肾积水导致 EBKT 术后肾动脉栓塞的病例,并着重介绍了该手术的技术细节和挑战:一名患有 MELAS 综合征的 18 岁女性接受了来自 10 个月大男婴的 EBKT。两个月后,患者出现单侧肾积水和反复尿路感染,常规治疗难以奏效。因此,我们对有问题的移植左肾进行了栓塞治疗。由于解剖结构复杂且存在多个角度,需要使用多个微导管、导线和支撑导管来选择肾动脉。由于常规血管造影不易观察到小分支和附属肾动脉的残余血流,因此需要反复进行手术:结论:EBKT术后选择性肾动脉栓塞因肾动脉长度短、角度多而具有挑战性,但通过使用细致的导管-导丝相互作用和辅助术中成像技术来精确划分靶动脉的解剖结构,仍可安全有效地进行栓塞:临床影响:与肾切除术相比,选择性肾动脉栓塞术创伤更小,如果在整体肾移植手术中必须不可避免地牺牲罪魁祸首的肾脏,则可以考虑使用这种方法。
{"title":"Technical Feasibility of Renal Artery Embolization on a Transplanted Kidney Due to Intractable Unilateral Hydronephrosis After En Bloc Kidney Transplantation: Case Report.","authors":"Dong-Hwan Kim, Hyung Sub Park, Young-Heun Shin, Chang Jin Yoon, Taeseung Lee","doi":"10.1177/15266028231159813","DOIUrl":"10.1177/15266028231159813","url":null,"abstract":"<p><strong>Introduction: </strong>En bloc kidney transplantation (EBKT) is a technique used to transplant pediatric kidneys to adult recipients, but can lead to certain complications seldom found in single-kidney transplantation. We report a case of renal artery embolization after EBKT due to intractable unilateral hydronephrosis and highlight the technical details and challenges of the procedure.</p><p><strong>Case: </strong>An 18-year-old female with MELAS syndrome underwent EBKT from a 10-month-old male baby. Two months later, the patient developed unilateral hydronephrosis and recurrent urinary tract infections, which was intractable to conventional therapy. Therefore, we underwent embolization of the problematic transplanted left kidney. Owing to the complicated anatomy and multiple angulations, multiple microcatheters, wires and support catheters were needed to select the renal arteries. Repeated procedures were required due to remnant flow from small branches and accessory renal arteries that were not easily visualized by conventional angiography, which were eventually detected by adjunctive use of 3-dimensional rotational angiography.</p><p><strong>Conclusions: </strong>Selective renal artery embolization after EBKT is challenging due to the short renal artery length and multiple angulations, yet it can still be performed safely and effectively by use of meticulous catheter-wire interactions and adjunctive intraoperative imaging techniques to delineate the precise anatomy of the target arteries.</p><p><strong>Clinical impact: </strong>Selective renal artery embolization, which is less invasive than nephrectomy, can be considered if the culprit kidney must inevitably be sacrificed in en bloc kidney transplantation.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1244-1251"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Propensity-Matched Comparison of Fenestrated Endovascular Aneurysm Repair and Open Surgical Repair of Complex Abdominal Aortic Aneurysms. 复杂腹主动脉瘤瓣膜内血管动脉瘤修补术与开放手术修补术的长期倾向匹配比较
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-28 DOI: 10.1177/15266028231162256
Giovanni Tinelli, Simona Sica, Jonathan Sobocinski, Zoé Ribreau, Chiara de Waure, Marco Ferraresi, Francesco Snider, Yamume Tshomba, Stéphan Haulon
<p><strong>Purpose: </strong>This study investigated the long-term outcomes of patients treated with fenestrated and branched endovascular aneurysm repair (F-BEVAR) or open surgical repair (OSR) for complex abdominal aortic aneurysms (c-AAAs). Complex abdominal aortic aneurysms are defined as aneurysms that involve the renal or mesenteric arteries and extend up to the level of the celiac axis or diaphragmatic hiatus but do not extend into the thoracic aorta. This study compares with a propensity-score matching the outcome of these procedures from 2 high-volume aortic centers.</p><p><strong>Materials and methods: </strong>All patients with c-AAAs undergoing repair at 2 centers between January 2010 and June 2016 were included. The long-term imaging follow-up consisted in a yearly computed tomography angiography (CTA) in the F-BEVAR group. Yearly abdominal ultrasound examination and 5-year CTA were performed in the OSR group. The primary endpoints were long-term mortality, aneurysm-related mortality, and chronic renal decline (CRD), defined as estimated glomerular filtration rate reduction to <60 mL/min/1.73 m<sup>2</sup> or >20%/de novo dependence on permanent dialysis in patients with normal or abnormal preoperative renal function, respectively. Secondary endpoints included aortic-related reinterventions, target vessel occlusion, proximal aorta degeneration, access-related complications, graft infection, and the composite endpoint of clinical failure during follow-up.</p><p><strong>Results: </strong>After 1:1 propensity matching, 102 consecutive patients who underwent F-BEVAR and OSR, respectively, were included. The median follow-up was 67 months. There was no significant difference in long-term overall mortality (40.2% vs 36.3%; p=0.40) and aneurysm-related mortality (6.8% vs 5.8%; p=0.30), in the F-BEVAR and OSR groups, respectively. During follow-up, late renal function decline occurred in 27 (27.8%) versus 46 patients (47.4%) in the F-BEVAR and OSR groups, respectively (p<0.01). During follow-up, 23 reinterventions (23.5%) were performed in the F-BEVAR group, and 5 (5.1%) in the OSR group (p<0.01).</p><p><strong>Conclusions: </strong>No differences in overall and aneurysm-related mortality were observed. Chronic renal decline was significantly higher after OSR, while the reintervention rate was higher in the F-BEVAR group. These long-term results reflect the outcomes of a complex procedure performed by a single experienced operator in 2 high-volume centers, and followed with a strict surveillance imaging follow-up.</p><p><strong>Clinical impact: </strong>Nowadays, F-BEVAR and OSR are considered two established techniques for the treatment of c-AAA. However, long-term comparative outcomes are not well studied, and concerns may rise in terms of durability of the repair, risk of reinterventions and late chronic renal decline. The present study showed, with a median follow-up > 5 years, no differences in overall and aneurysm-related mortality. Ch
目的:本研究调查了复杂性腹主动脉瘤(c-AAAs)患者接受开窗和分支血管内动脉瘤修补术(F-BEVAR)或开放手术修补术(OSR)治疗后的长期疗效。复杂腹主动脉瘤的定义是累及肾动脉或肠系膜动脉并延伸至腹腔轴或膈裂水平但未延伸至胸主动脉的动脉瘤。本研究比较了两个大容量主动脉中心这些手术的倾向得分匹配结果:纳入2010年1月至2016年6月期间在2个中心接受修复手术的所有c-AAAs患者。F-BEVAR组的长期影像学随访包括每年一次的计算机断层扫描(CTA)。OSR组每年进行一次腹部超声检查和5年CTA检查。主要终点是长期死亡率、动脉瘤相关死亡率和慢性肾功能衰退(CRD),分别定义为术前肾功能正常或异常的患者估计肾小球滤过率下降至2%或>20%/重新依赖永久性透析。次要终点包括主动脉相关再介入、靶血管闭塞、近端主动脉变性、入路相关并发症、移植物感染以及随访期间临床失败的复合终点:结果:经过1:1倾向匹配,102名连续患者分别接受了F-BEVAR和OSR手术。中位随访时间为 67 个月。F-BEVAR组和OSR组的长期总死亡率(40.2% vs 36.3%;P=0.40)和动脉瘤相关死亡率(6.8% vs 5.8%;P=0.30)分别没有明显差异。在随访期间,F-BEVAR组和OSR组分别有27例(27.8%)和46例(47.4%)患者出现晚期肾功能衰退(P结论:在总体死亡率和动脉瘤相关死亡率方面未观察到差异。OSR术后慢性肾功能衰竭率明显升高,而F-BEVAR组的再介入率较高。这些长期结果反映了在两个大容量中心由一名经验丰富的操作者实施的复杂手术的结果,并进行了严格的监测成像随访:临床影响:如今,F-BEVAR 和 OSR 被认为是治疗 c-AAA 的两种成熟技术。临床影响:目前,F-BEVAR 和 OSR 被认为是治疗 c-AAA 的两种成熟技术,但长期比较结果的研究并不多,人们可能会对修复的耐久性、再次干预的风险和晚期慢性肾功能衰退产生担忧。本研究显示,在中位随访时间大于 5 年的情况下,总死亡率和动脉瘤相关死亡率没有差异。OSR术后慢性肾功能衰退率明显较高,而血管内介入组的再介入率较高。为了获得最佳的长期疗效,这两种技术都应在大容量主动脉中心进行,根据患者情况量身定制,并进行充分的监测成像。
{"title":"Long-Term Propensity-Matched Comparison of Fenestrated Endovascular Aneurysm Repair and Open Surgical Repair of Complex Abdominal Aortic Aneurysms.","authors":"Giovanni Tinelli, Simona Sica, Jonathan Sobocinski, Zoé Ribreau, Chiara de Waure, Marco Ferraresi, Francesco Snider, Yamume Tshomba, Stéphan Haulon","doi":"10.1177/15266028231162256","DOIUrl":"10.1177/15266028231162256","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study investigated the long-term outcomes of patients treated with fenestrated and branched endovascular aneurysm repair (F-BEVAR) or open surgical repair (OSR) for complex abdominal aortic aneurysms (c-AAAs). Complex abdominal aortic aneurysms are defined as aneurysms that involve the renal or mesenteric arteries and extend up to the level of the celiac axis or diaphragmatic hiatus but do not extend into the thoracic aorta. This study compares with a propensity-score matching the outcome of these procedures from 2 high-volume aortic centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;All patients with c-AAAs undergoing repair at 2 centers between January 2010 and June 2016 were included. The long-term imaging follow-up consisted in a yearly computed tomography angiography (CTA) in the F-BEVAR group. Yearly abdominal ultrasound examination and 5-year CTA were performed in the OSR group. The primary endpoints were long-term mortality, aneurysm-related mortality, and chronic renal decline (CRD), defined as estimated glomerular filtration rate reduction to &lt;60 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; or &gt;20%/de novo dependence on permanent dialysis in patients with normal or abnormal preoperative renal function, respectively. Secondary endpoints included aortic-related reinterventions, target vessel occlusion, proximal aorta degeneration, access-related complications, graft infection, and the composite endpoint of clinical failure during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After 1:1 propensity matching, 102 consecutive patients who underwent F-BEVAR and OSR, respectively, were included. The median follow-up was 67 months. There was no significant difference in long-term overall mortality (40.2% vs 36.3%; p=0.40) and aneurysm-related mortality (6.8% vs 5.8%; p=0.30), in the F-BEVAR and OSR groups, respectively. During follow-up, late renal function decline occurred in 27 (27.8%) versus 46 patients (47.4%) in the F-BEVAR and OSR groups, respectively (p&lt;0.01). During follow-up, 23 reinterventions (23.5%) were performed in the F-BEVAR group, and 5 (5.1%) in the OSR group (p&lt;0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;No differences in overall and aneurysm-related mortality were observed. Chronic renal decline was significantly higher after OSR, while the reintervention rate was higher in the F-BEVAR group. These long-term results reflect the outcomes of a complex procedure performed by a single experienced operator in 2 high-volume centers, and followed with a strict surveillance imaging follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;Nowadays, F-BEVAR and OSR are considered two established techniques for the treatment of c-AAA. However, long-term comparative outcomes are not well studied, and concerns may rise in terms of durability of the repair, risk of reinterventions and late chronic renal decline. The present study showed, with a median follow-up &gt; 5 years, no differences in overall and aneurysm-related mortality. Ch","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1208-1217"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular Management of Combined Symptomatic Spontaneous Isolated Renal and Celiac Arterial Dissection: A Case Report. 合并症状性自发性孤立肾动脉和腹腔动脉夹层的血管内治疗:病例报告
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-25 DOI: 10.1177/15266028231163061
Omar El Kashef, Mohammed Noureldin

Purpose: To report a unique entity and its management that occurred at our facility: combined spontaneous isolated renal and celiac arterial dissection (SIRCAD) with resultant renal and gastrointestinal symptoms.

Case report: A 50-year-old man with no past medical history presented with a 4 day history of nausea, intermittent stabbing epigastric pain, right flank pain, and uncontrolled hypertension. After full physical examination and imaging studies, the diagnosis of SIRCAD was established and confirmed. Selective right renal artery catheterization revealed dissection limited to the main trunk, and after careful selective hand-injection and successful cannulation of the distal renal artery branches through the true lumen assisted by intravascular ultrasound, a balloon expandable covered stent (6 mm in diameter and 60 mm in length) was deployed in the main renal artery. The same steps were performed for management of the celiac artery dissection. The patient was treated with clopidogrel 75 mg for 6 weeks and lifetime aspirin. A week after the procedure, his symptoms completely resolved.

Conclusion: The pathology of SIRCAD in the absence of other vascular dissections is extremely rare, which speaks for the necessity of reporting this case and highlights the great role of evolving imaging modalities in the diagnosis and management of such cases.

Clinical impact: Symptomatic combined spontaneous isolated renal and celiac arterial dissection (SIRCAD) remain rare despite the increased frequency of reports on asymptomatic dissections. The etiology of SIRCAD is not precisely defined. Moreover, treatment of SIRCAD remains controversial with only a few cases of percutaneous interventional treatment are reported in the literature.

目的:报告本院发生的一个独特病例及其处理方法:合并自发性孤立肾脏和腹腔动脉夹层(SIRCAD),导致肾脏和胃肠道症状:一名无病史的 50 岁男子因恶心、间歇性上腹部刺痛、右侧腹痛和无法控制的高血压就诊 4 天。经过全面体检和影像学检查,确定并确诊为 SIRCAD。选择性右肾动脉导管检查显示,夹层仅限于主干,在血管内超声辅助下,经过仔细的选择性手工注射并成功通过真腔对远端肾动脉分支进行插管后,在主肾动脉中植入了一个球囊扩张覆盖支架(直径 6 毫米,长 60 毫米)。腹腔动脉夹层的处理步骤相同。患者接受了为期 6 周的 75 毫克氯吡格雷治疗,并终生服用阿司匹林。术后一周,患者症状完全缓解:结论:在没有其他血管解剖的情况下,SIRCAD 的病理变化极为罕见,这说明了报告此病例的必要性,并强调了不断发展的成像模式在此类病例的诊断和管理中的巨大作用:临床影响:无症状合并自发性孤立肾动脉和腹腔动脉夹层(SIRCAD)仍然罕见,尽管有关无症状夹层的报道越来越多。SIRCAD 的病因尚未明确。此外,SIRCAD 的治疗仍存在争议,文献中仅报道了几例经皮介入治疗的病例。
{"title":"Endovascular Management of Combined Symptomatic Spontaneous Isolated Renal and Celiac Arterial Dissection: A Case Report.","authors":"Omar El Kashef, Mohammed Noureldin","doi":"10.1177/15266028231163061","DOIUrl":"10.1177/15266028231163061","url":null,"abstract":"<p><strong>Purpose: </strong>To report a unique entity and its management that occurred at our facility: combined spontaneous isolated renal and celiac arterial dissection (SIRCAD) with resultant renal and gastrointestinal symptoms.</p><p><strong>Case report: </strong>A 50-year-old man with no past medical history presented with a 4 day history of nausea, intermittent stabbing epigastric pain, right flank pain, and uncontrolled hypertension. After full physical examination and imaging studies, the diagnosis of SIRCAD was established and confirmed. Selective right renal artery catheterization revealed dissection limited to the main trunk, and after careful selective hand-injection and successful cannulation of the distal renal artery branches through the true lumen assisted by intravascular ultrasound, a balloon expandable covered stent (6 mm in diameter and 60 mm in length) was deployed in the main renal artery. The same steps were performed for management of the celiac artery dissection. The patient was treated with clopidogrel 75 mg for 6 weeks and lifetime aspirin. A week after the procedure, his symptoms completely resolved.</p><p><strong>Conclusion: </strong>The pathology of SIRCAD in the absence of other vascular dissections is extremely rare, which speaks for the necessity of reporting this case and highlights the great role of evolving imaging modalities in the diagnosis and management of such cases.</p><p><strong>Clinical impact: </strong>Symptomatic combined spontaneous isolated renal and celiac arterial dissection (SIRCAD) remain rare despite the increased frequency of reports on asymptomatic dissections. The etiology of SIRCAD is not precisely defined. Moreover, treatment of SIRCAD remains controversial with only a few cases of percutaneous interventional treatment are reported in the literature.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1262-1267"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Morphological and Clinical Predictors of Early/Follow-up Failure of the Endovascular Infrarenal Abdominal Aneurysm Repair With Currently Available Endografts. 使用现有内移植物进行血管内肾下腹腔动脉瘤修补术早期/后续失败的形态学和临床预测因素
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-04 DOI: 10.1177/15266028231158312
Enrico Gallitto, Gianluca Faggioli, Chiara Mascoli, Martina Goretti, Rodolfo Pini, Antonino Logiacco, Cristina Rocchi, Francesca Feroldi, Stefania Caputo, Mauro Gargiulo
<p><strong>Purpose: </strong>To report outcomes of endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs) with currently-available endografts and identify predictors of technical/clinical failure.</p><p><strong>Materials and methods: </strong>Patients undergoing EVAR between 2012 and 2020 were prospectively collected and retrospectively analyzed. Technical success (TS: no type I-III endoleaks, renal/hypogastric arteries loss, iliac leg occlusion, conversion to open repair and mortality within 24 postoperative hour), proximal neck-related TS (nr-TS: no proximal type I endoleaks, unplanned renal arteries coverage), and 30-day mortality were assessed as early outcomes. Proximal type I endoleak (ELIa), survival and freedom from reinterventions (FFRs) were assessed during follow-up. Uni/multivariate analysis and Cox-regression were used to identified factors associated with early and follow-up outcomes; FFR and survival were assessed by Kaplan-Meier analysis.</p><p><strong>Results: </strong>A total of 710 were included. Technical success and nr-TS were 692 (98%) and 700 (99%), respectively. The presence of ≥2 hostile anatomical infrarenal neck characteristics was associated with technical failure (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.3-4.1; p: 0.007). Infrarenal neck angle >90° (OR: 2.88; 95% CI: 9.6-50.3; p: 0.004), barrel shape (OR: 2.33; 95% CI: 11.1-100.3; p: 0.02) or presence of ≥2 hostile anatomical infrarenal neck characteristics (OR: 2.16; 95% CI: 2.5-5.3; p: 0.03) were independent risk factors for neck-related technical failures. Six (0.8%) patients died within 30 postoperative days. Chronic obstructive pulmonary disease (OR: 16; 95% CI: 1.1-218.3; p: 0.04) and urgent repair (OR: 15; 95% CI: 1.8-119.6; p: 0.01) were independent risk factors for 30-day mortality. The mean follow-up was 53±13 months. There were 12 (1.7%) ELIa during follow-up. Infrarenal neck length <15 mm (hazard ratio [HR]: 2.8; 95% CI: 1.9-9.6; p: 0.005), diameter >28 mm (HR: 2.7; 95% CI: 1.6-9.5; p: 0.006), angle ≥90° (HR: 2.7; 95% CI: 8.3-50.1; p: 0.007), and persistent type II endoleak (HR: 2.9; 95% CI: 1.6-10.1; p: 0.004) were independent risk factors for ELIa. Freedom from reintervention was 91% at 5 years. The ELIa was an independent risk factor for reinterventions during follow-up (HR: 29.5; 95% CI: 1.4-1.6; p<0.001). Survival was 74% at 5 years with 2 cases (0.3%) of late aortic-related mortality. Peripheral arterial occlusive disease (HR: 1.9; 95% CI: 1.4-3.65; p: 0.03), aneurysm diameter ≥65 mm (HR: 2.2; 95% CI: 1.4-3.26; p<0.001), and infrarenal neck length <15 mm (HR: 1.7; 95% CI: 1.2-2.35; p: 0.04) were independent risk factors for mortality during follow-up.</p><p><strong>Conclusion: </strong>Endovascular repair with currently-available endografts has high TS and low 30-day mortality. Survival and FFRs were satisfactory at mid-term. Pre/postoperative risk factors for technical and clinical failure were identified and they sh
目的:报告使用目前可用的内植物对肾下腹主动脉瘤(AAA)进行血管内修复(EVAR)的结果,并确定技术/临床失败的预测因素:对2012年至2020年间接受EVAR手术的患者进行前瞻性收集和回顾性分析。技术成功率(TS:无 I-III 型内膜渗漏、肾动脉/腹股沟动脉缺失、髂腿闭塞、术后 24 小时内转为开放式修复和死亡)、近端颈部相关 TS(nr-TS:无近端 I 型内膜渗漏、计划外肾动脉覆盖)和 30 天死亡率作为早期结果进行评估。随访期间评估了近端I型内漏(ELIa)、存活率和免再介入(FFR)。采用单变量/多变量分析和 Cox 回归确定与早期和随访结果相关的因素;采用 Kaplan-Meier 分析评估 FFR 和存活率:结果:共纳入710例患者。结果:共纳入 710 例患者,技术成功率和 nr-TS 分别为 692 例(98%)和 700 例(99%)。存在≥2个敌意解剖学肾下颈特征与技术失败相关(几率比[OR]:2.4;95%置信区间[CI]:1.3-4.1;P:0.007)。椎管内颈部角度>90°(OR:2.88;95% CI:9.6-50.3;P:0.004)、桶状(OR:2.33;95% CI:11.1-100.3;P:0.02)或存在≥2个敌对的解剖学椎管内颈部特征(OR:2.16;95% CI:2.5-5.3;P:0.03)是颈部相关技术失败的独立风险因素。6名(0.8%)患者在术后30天内死亡。慢性阻塞性肺病(OR:16;95% CI:1.1-218.3;P:0.04)和紧急修复(OR:15;95% CI:1.8-119.6;P:0.01)是术后 30 天内死亡的独立风险因素。平均随访时间为 53±13 个月。随访期间有12例(1.7%)ELIa。肾盂颈长度 28 mm(HR:2.7;95% CI:1.6-9.5;P:0.006)、角度≥90°(HR:2.7;95% CI:8.3-50.1;P:0.007)和持续性 II 型内漏(HR:2.9;95% CI:1.6-10.1;P:0.004)是 ELIa 的独立危险因素。5年后,91%的患者免于再次介入治疗。ELIa是随访期间再干预的独立风险因素(HR:29.5;95% CI:1.4-1.6;p):使用目前可用的血管内移植物进行血管内修复具有较高的 TS 值和较低的 30 天死亡率。中期存活率和 FFR 均令人满意。发现了技术和临床失败的术前/术后风险因素,这些因素应在 EVAR 适应症和术后管理中加以考虑,以减少并发症并改善中期预后:临床影响:可以确定EVAR技术和临床失败的术前和术后风险因素,在EVAR适应症和术后管理中应考虑这些因素,以减少并发症,改善中期预后。
{"title":"Morphological and Clinical Predictors of Early/Follow-up Failure of the Endovascular Infrarenal Abdominal Aneurysm Repair With Currently Available Endografts.","authors":"Enrico Gallitto, Gianluca Faggioli, Chiara Mascoli, Martina Goretti, Rodolfo Pini, Antonino Logiacco, Cristina Rocchi, Francesca Feroldi, Stefania Caputo, Mauro Gargiulo","doi":"10.1177/15266028231158312","DOIUrl":"10.1177/15266028231158312","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To report outcomes of endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs) with currently-available endografts and identify predictors of technical/clinical failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Patients undergoing EVAR between 2012 and 2020 were prospectively collected and retrospectively analyzed. Technical success (TS: no type I-III endoleaks, renal/hypogastric arteries loss, iliac leg occlusion, conversion to open repair and mortality within 24 postoperative hour), proximal neck-related TS (nr-TS: no proximal type I endoleaks, unplanned renal arteries coverage), and 30-day mortality were assessed as early outcomes. Proximal type I endoleak (ELIa), survival and freedom from reinterventions (FFRs) were assessed during follow-up. Uni/multivariate analysis and Cox-regression were used to identified factors associated with early and follow-up outcomes; FFR and survival were assessed by Kaplan-Meier analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 710 were included. Technical success and nr-TS were 692 (98%) and 700 (99%), respectively. The presence of ≥2 hostile anatomical infrarenal neck characteristics was associated with technical failure (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.3-4.1; p: 0.007). Infrarenal neck angle &gt;90° (OR: 2.88; 95% CI: 9.6-50.3; p: 0.004), barrel shape (OR: 2.33; 95% CI: 11.1-100.3; p: 0.02) or presence of ≥2 hostile anatomical infrarenal neck characteristics (OR: 2.16; 95% CI: 2.5-5.3; p: 0.03) were independent risk factors for neck-related technical failures. Six (0.8%) patients died within 30 postoperative days. Chronic obstructive pulmonary disease (OR: 16; 95% CI: 1.1-218.3; p: 0.04) and urgent repair (OR: 15; 95% CI: 1.8-119.6; p: 0.01) were independent risk factors for 30-day mortality. The mean follow-up was 53±13 months. There were 12 (1.7%) ELIa during follow-up. Infrarenal neck length &lt;15 mm (hazard ratio [HR]: 2.8; 95% CI: 1.9-9.6; p: 0.005), diameter &gt;28 mm (HR: 2.7; 95% CI: 1.6-9.5; p: 0.006), angle ≥90° (HR: 2.7; 95% CI: 8.3-50.1; p: 0.007), and persistent type II endoleak (HR: 2.9; 95% CI: 1.6-10.1; p: 0.004) were independent risk factors for ELIa. Freedom from reintervention was 91% at 5 years. The ELIa was an independent risk factor for reinterventions during follow-up (HR: 29.5; 95% CI: 1.4-1.6; p&lt;0.001). Survival was 74% at 5 years with 2 cases (0.3%) of late aortic-related mortality. Peripheral arterial occlusive disease (HR: 1.9; 95% CI: 1.4-3.65; p: 0.03), aneurysm diameter ≥65 mm (HR: 2.2; 95% CI: 1.4-3.26; p&lt;0.001), and infrarenal neck length &lt;15 mm (HR: 1.7; 95% CI: 1.2-2.35; p: 0.04) were independent risk factors for mortality during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Endovascular repair with currently-available endografts has high TS and low 30-day mortality. Survival and FFRs were satisfactory at mid-term. Pre/postoperative risk factors for technical and clinical failure were identified and they sh","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1130-1139"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9078721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Look For the Wire . . . Before You Leap! 寻找电线 .. .跳跃之前
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-15 DOI: 10.1177/15266028231159809
Cristina Lopez-Espada, Nicolás Maldonado Fernández, Jose Patricio Linares-Palomino
{"title":"Look For the Wire . . . Before You Leap!","authors":"Cristina Lopez-Espada, Nicolás Maldonado Fernández, Jose Patricio Linares-Palomino","doi":"10.1177/15266028231159809","DOIUrl":"10.1177/15266028231159809","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1074"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9114288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predicting and Analyzing Restenosis Risk after Endovascular Treatment in Lower Extremity Arterial Disease: Development and Assessment of a Predictive Nomogram. 预测和分析下肢动脉疾病血管内治疗后的再狭窄风险:下肢动脉疾病血管内治疗后再狭窄风险的预测与分析:预测提名图的开发与评估。
IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-01 Epub Date: 2023-03-08 DOI: 10.1177/15266028231158294
Jinxing Chen, Yanan Tang, Zekun Shen, Weiyi Wang, Jiaxuan Hou, Jiayan Li, Bingyi Chen, Yifan Mei, Shuang Liu, Liwei Zhang, Shaoying Lu

Purpose: This study aimed to develop and internally validate nomograms for predicting restenosis after endovascular treatment of lower extremity arterial diseases.

Materials and methods: A total of 181 hospitalized patients with lower extremity arterial disease diagnosed for the first time between 2018 and 2019 were retrospectively collected. Patients were randomly divided into a primary cohort (n=127) and a validation cohort (n=54) at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression was used to optimize the feature selection of the prediction model. Combined with the best characteristics of LASSO regression, the prediction model was established by multivariate Cox regression analysis. The predictive models' identification, calibration, and clinical practicability were evaluated by the C index, calibration curve, and decision curve. The prognosis of patients with different grades was compared by survival analysis. Internal validation of the model used data from the validation cohort.

Results: The predictive factors included in the nomogram were lesion site, use of antiplatelet drugs, application of drug coating technology, calibration, coronary heart disease, and international normalized ratio (INR). The prediction model demonstrated good calibration ability, and the C index was 0.762 (95% confidence interval: 0.691-0.823). The C index of the validation cohort was 0.864 (95% confidence interval: 0.801-0.927), which also showed good calibration ability. The decision curve shows that when the threshold probability of the prediction model is more significant than 2.5%, the patients benefit significantly from our prediction model, and the maximum net benefit rate is 30.9%. Patients were graded according to the nomogram. Survival analysis found that there was a significant difference in the postoperative primary patency rate between patients of different classifications (log-rank p<0.001) in both the primary cohort and the validation cohort.

Conclusion: We developed a nomogram to predict the risk of target vessel restenosis after endovascular treatment by considering information on lesion site, postoperative antiplatelet drugs, calcification, coronary heart disease, drug coating technology, and INR.

Clinical impact: Clinicians can grade patients after endovascular procedure according to the scores of the nomograms and apply intervention measures of different intensities for people at different risk levels. During the follow-up process, an individualized follow-up plan can be further formulated according to the risk classification. Identifying and analyzing risk factors is essential for making appropriate clinical decisions to prevent restenosis.

目的:本研究旨在开发并在内部验证用于预测下肢动脉疾病血管内治疗后再狭窄的提名图:回顾性收集2018年至2019年期间首次确诊的181例下肢动脉疾病住院患者。患者按 7:3 的比例随机分为初选队列(n=127)和验证队列(n=54)。采用最小绝对收缩和选择算子(LASSO)回归优化预测模型的特征选择。结合 LASSO 回归的最佳特征,通过多变量 Cox 回归分析建立了预测模型。预测模型的识别、校准和临床实用性通过C指数、校准曲线和决策曲线进行评估。通过生存分析比较了不同等级患者的预后。利用验证队列的数据对模型进行了内部验证:提名图中的预测因素包括病变部位、抗血小板药物的使用、药物涂层技术的应用、校准、冠心病和国际正常化比值(INR)。预测模型显示出良好的校准能力,C 指数为 0.762(95% 置信区间:0.691-0.823)。验证队列的 C 指数为 0.864(95% 置信区间:0.801-0.927),也显示出良好的校准能力。决策曲线显示,当预测模型的阈值概率大于 2.5%时,患者从我们的预测模型中获益显著,最大净获益率为 30.9%。根据提名图对患者进行分级。生存分析发现,不同分级患者的术后一次通畅率存在显著差异(log-rank p):我们开发了一种提名图,通过考虑病变部位、术后抗血小板药物、钙化、冠心病、药物涂层技术和 INR 等信息来预测血管内治疗后靶血管再狭窄的风险:临床影响:临床医生可根据提名图的评分对血管内治疗后的患者进行分级,并针对不同风险级别的患者采取不同强度的干预措施。在随访过程中,可根据风险分级进一步制定个性化的随访计划。识别和分析风险因素对于做出适当的临床决策以预防再狭窄至关重要。
{"title":"Predicting and Analyzing Restenosis Risk after Endovascular Treatment in Lower Extremity Arterial Disease: Development and Assessment of a Predictive Nomogram.","authors":"Jinxing Chen, Yanan Tang, Zekun Shen, Weiyi Wang, Jiaxuan Hou, Jiayan Li, Bingyi Chen, Yifan Mei, Shuang Liu, Liwei Zhang, Shaoying Lu","doi":"10.1177/15266028231158294","DOIUrl":"10.1177/15266028231158294","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop and internally validate nomograms for predicting restenosis after endovascular treatment of lower extremity arterial diseases.</p><p><strong>Materials and methods: </strong>A total of 181 hospitalized patients with lower extremity arterial disease diagnosed for the first time between 2018 and 2019 were retrospectively collected. Patients were randomly divided into a primary cohort (n=127) and a validation cohort (n=54) at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression was used to optimize the feature selection of the prediction model. Combined with the best characteristics of LASSO regression, the prediction model was established by multivariate Cox regression analysis. The predictive models' identification, calibration, and clinical practicability were evaluated by the C index, calibration curve, and decision curve. The prognosis of patients with different grades was compared by survival analysis. Internal validation of the model used data from the validation cohort.</p><p><strong>Results: </strong>The predictive factors included in the nomogram were lesion site, use of antiplatelet drugs, application of drug coating technology, calibration, coronary heart disease, and international normalized ratio (INR). The prediction model demonstrated good calibration ability, and the C index was 0.762 (95% confidence interval: 0.691-0.823). The C index of the validation cohort was 0.864 (95% confidence interval: 0.801-0.927), which also showed good calibration ability. The decision curve shows that when the threshold probability of the prediction model is more significant than 2.5%, the patients benefit significantly from our prediction model, and the maximum net benefit rate is 30.9%. Patients were graded according to the nomogram. Survival analysis found that there was a significant difference in the postoperative primary patency rate between patients of different classifications (log-rank p<0.001) in both the primary cohort and the validation cohort.</p><p><strong>Conclusion: </strong>We developed a nomogram to predict the risk of target vessel restenosis after endovascular treatment by considering information on lesion site, postoperative antiplatelet drugs, calcification, coronary heart disease, drug coating technology, and INR.</p><p><strong>Clinical impact: </strong>Clinicians can grade patients after endovascular procedure according to the scores of the nomograms and apply intervention measures of different intensities for people at different risk levels. During the follow-up process, an individualized follow-up plan can be further formulated according to the risk classification. Identifying and analyzing risk factors is essential for making appropriate clinical decisions to prevent restenosis.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1140-1149"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9132731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Endovascular Therapy
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1