Vascular Specialist International最新文献

Venous adventitial cystic disease (VACD) is a rare vascular disorder characterized by mucin-filled cysts in the venous adventitia. We encountered five patients who presented to our vascular clinic with an initial diagnosis of deep vein thrombosis (DVT) but were later diagnosed with VACD on imaging. The patients were aged 64-81 years; lesion locations included the common femoral vein (n=3), external iliac vein (n=1), and popliteal vein (n=1). Four patients underwent surgical intervention, and one patient received conservative management with medical therapy. All surgically treated patients demonstrated improvement in leg swelling after complete cyst excision. One of the two patients with concomitant thrombus developed a massive pulmonary embolism with hemodynamic instability following catheter-directed mechanical thrombectomy. VACD can mimic DVT; however, computed tomography together with duplex ultrasonography is usually sufficient for differentiation. Thrombosis may occur secondary to outflow obstruction, and complete cyst excision remains the treatment of choice.

Left atrial intramural hematoma (LAIH) is a rare complication related to various cardiac interventions, including cardiac surgery, catheter-based arrhythmia ablation, and percutaneous coronary intervention (PCI), all of which may involve manipulation of the left atrium (LA). Here, we describe the challenging management of a patient who developed LAIH after PCI. A 72-year-old male patient was transferred to our hospital for the management of LAIH after PCI. Owing to cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. Repeat coronary angiography confirmed perforation of the left circumflex coronary artery; thus, coil embolization was performed. Subsequently, emergency surgical evacuation of the LA hematoma was performed to relieve the hemodynamic instability and impaired intracavitary flow. ECMO was weaned the day after surgery, and the patient made a full recovery. Even in critically ill patients, staged management with ECMO support should be considered to facilitate recovery.

These clinical practice guidelines (CPG) were developed by the Korean Society for Vascular Surgery to provide evidence-based recommendations for the management and post-treatment surveillance of abdominal aortic aneurysms (AAAs). The guidelines were developed by a multidisciplinary guideline working committee of 19 members, including vascular surgeons and methodological experts. A total of 18 key clinical questions focusing on AAA management and surveillance after treatment were selected. Based on systematic reviews and meta-analyses of the available literature, literature searches were performed in MEDLINE (via PubMed), EMBASE, Cochrane Central, and KoreaMed up to February 3, 2022. Additional searches for two questions were conducted in September 2022 and December 2023. Recommendations were formulated through structured evidence review and consensus, following a Cochrane-based grading system with modifications in terminology and structure. Eighteen recommendations were made, covering surgical indications, comparison of open surgical repair and endovascular aneurysm repair, postoperative complication management, and surveillance strategies. Each recommendation was assigned a strength (strong or conditional) and direction (do or do not), along with an evidence level (high, moderate, low, or very low). These CPGs provide a structured, evidence-based framework to guide clinical decision-making in the management of AAAs.

Radial arteriovenous fistulas (AVFs), although rare and usually trauma-related, are being observed more frequently due to the growing popularity of transradial catheterization. Treatment options include physical compression, surgical repair, or endovascular intervention. While surgical ligation remains the standard treatment for most extremity AVFs, treatment failure and recurrence have been reported. Endovascular embolization with N-butyl cyanoacrylate (NBCA) is well established in neurovascular and visceral interventions; however, its application in extremity AVFs has rarely been documented. We present a case of recurrent post-traumatic radial AVF successfully treated using NBCA as the sole embolic agent in a single session following failed surgical ligation. This case highlights a technically simple and cost-effective approach using microcatheter-based glue embolization and blood pressure cuff-assisted flow control. A brief literature review is also provided, comparing this technique with other endovascular treatment options, including stent graft placement and balloon-assisted glue embolization.

Purpose: Behçet disease can cause aortitis and aortic aneurysms. Although open surgery has been a standard treatment, endovascular repair may be beneficial when combined with immunosuppressive therapies. This study assessed the outcome of endovascular stent-graft placement with adjuvant immunosuppressive therapy in aortic aneurysms and pseudoaneurysms associated with Behçet disease.

Materials and methods: Nine patients with Behçet disease were diagnosed with 10 aortic aneurysms between February 2018 and August 2023. Immunosuppressive medication was administered to all patients prior to intervention to achieve remission. We reviewed procedural details and follow-up imaging to assess technical success, complications, and reinterventions. After discharge, patients received routine follow-up at 3-month intervals.

Results: All patients were male, with a mean age of 42.1 years. Tube stent-grafts were used in all patients; one patient additionally underwent endovascular aneurysm repair with a bifurcated graft. Three patients underwent debranching procedures prior to endovascular stent-graft placement. Technical success was achieved in all procedures. During follow-up, two patients died (one on postoperative day 6 due to myocardial infarction and another on postoperative day 40 due to mediastinitis). Two patients developed access-site pseudoaneurysms, and one patient required secondary intervention for stent-graft migration with a type Ib endoleak. No graft infection, sac expansion, or attachment-site pseudoaneurysm was identified.

Conclusion: In patients with Behçet disease, endovascular stent-graft repair combined with immunosuppressive therapy appears to be safe and effective treatments for aortic aneurysms or pseudoaneurysms.

Patients with chronic limb-threatening ischemia (CLTI) are typically older adults with multiple comorbidities, placing them at high risk for major amputation and mortality. As CLTI frequently occurs in patients with diabetes or end-stage renal disease, it often presents as stenosis or occlusion with calcification of the infrapopliteal (IP) arteries. Endovascular therapy (EVT) has become widely adopted as a first-line treatment and an alternative to surgical bypass in the management of CLTI, owing to its high technical success rate and favorable limb salvage rate. However, IP lesions in patients with CLTI are often long, diffuse, heavily calcified, and totally occluded and may extend below the ankle, making it challenging to achieve optimal procedural success and long-term durability. This review aimed to explore current treatment strategies for CLTI associated with IP artery disease and discuss practical techniques for achieving successful EVT.

Severe aortoiliac occlusive disease (AIOD), particularly TransAtlantic Inter-Society Consensus (TASC) II C/D lesions, presents a therapeutic challenge and has traditionally been managed with aortobifemoral bypass, which offers durable patency but carries substantial perioperative morbidity and mortality. Endovascular approaches, including bifurcated endografts, have emerged as less invasive alternatives, demonstrating favorable patency outcomes, technical advantages, and reduced hospital stays. We present the case of a 49-year-old male with complex TASC II D lesions who was successfully treated with a bifurcated endograft. The procedure achieved complete revascularization without perioperative complications, and one-year follow-up confirmed durable patency. This case highlights the feasibility of bifurcated endografts in selected high-risk patients with advanced AIOD. Although encouraging, their application in non-aneurysmal disease remains off-label, underscoring the need for long-term and comparative studies to validate outcomes and guide patient selection.

Vascular closure devices (VCDs) allow rapid hemostasis after endovascular procedures but may rarely cause pseudoaneurysms or infections. Infected pseudoaneurysms of the common femoral artery (CFA) following VCD use are uncommon, and stent-graft exclusion is discouraged in infected fields and high-motion sites such as the groin. We report a 68-year-old male with end-stage renal disease on hemodialysis who developed an infected CFA pseudoaneurysm after VCD and subsequent stent-graft placement. The lesion was complicated by vancomycin-intermediate Staphylococcus aureus bacteremia and arterial wall destruction. Surgical debridement and excision of the infected stent-graft were followed by autologous spiral vein graft reconstruction using the contralateral great saphenous vein, extending from the external iliac artery to the proximal superficial femoral artery. Postoperative cultures revealed methicillin-resistant Staphylococcus aureus infection. The patient recovered uneventfully with patent reconstruction and no recurrence. This case highlights the risk of VCD-related infections and supports spiral vein grafting as a durable option.

Peripheral arterial disease (PAD) causes progressive arterial narrowing that limits blood flow to the limbs, often resulting in pain, non-healing wounds, and risk of amputation. In advanced cases without distal arterial targets, conventional revascularization is not feasible, necessitating alternative strategies. We report the case of a 68-year-old man with diabetes and advanced PAD who presented with foot necrosis. Angiography revealed complete occlusion of the anterior tibial, posterior tibial, and peroneal arteries, with no distal runoff. After unsuccessful angioplasty, an endovascular arteriovenous fistula was created between the posterior tibial artery and the plantar venous system to restore perfusion. Despite postoperative complications, including infection, the patient demonstrated progressive improvement after partial amputation, achieving complete wound healing by 25 weeks. This case highlights endovascular arterialization of the venous plantar arch via the posterior tibial artery as a promising limb-salvage technique for patients without conventional revascularization options.