Vascular Specialist International最新文献

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.

Purpose: Large language models (LLMs) can generate clinically relevant text; however, their performance in highly specialized medical domains remains uncertain. This study evaluated ChatGPT-3.5 and ChatGPT-4 (OpenAI) using vascular surgery board-style questions from the Vascular Education and Self-Assessment Program, version 4 (VESAP4) and compared the two public model versions (June and November 2023).

Materials and methods: All non-image VESAP4 questions (n=384) were presented independently three times to each model version (ChatGPT-3.5 June/November; ChatGPT-4, June/November). Outcomes included accuracy (proportion correct), consistency (same option letter across all three attempts and "consistently correct"), explanation length (word count), and modes of failure classified for a pre-specified index attempt using a multi-label taxonomy, with independent dual review and consensus. Accuracy and consistency were reported with 95% confidence intervals, and between-condition differences were compared using the chi-square (proportions) and Welch t-test (word count).

Results: Accuracy was 47.9% and 46.5% for ChatGPT-3.5 (June/November) and 62.4% and 63.8% for ChatGPT-4, respectively. No significant within-model improvement occurred between June and November, whereas ChatGPT-4 outperformed ChatGPT-3.5 in both months (P<0.0001). For consistency, ChatGPT-3.5 increased in "same-letter" (55.5% to 65.6%; P=0.004) with no change in "consistently correct" (40.6% to 40.4%; P=0.94). ChatGPT-4 decreased in "same-letter" (90.1% to 79.7%; P<0.0001) with stable "consistently correct" (60.4% to 58.6%; P=0.61). Between the models, ChatGPT-4 exceeded ChatGPT-3.5 on both consistency metrics in June and November (all P<0.0001). Explanation length shifted within models: ChatGPT-3.5 produced shorter responses in November compared with June (105.4±1.0 vs. 164.2±1.5 words; P<0.0001), whereas ChatGPT-4 produced longer responses (282.0±1.3 vs. 120.0±1.2 words; P<0.0001). Performance across VESAP4 subsections was higher for Vascular Medicine and Radiological Imaging/Radiation Safety, and lower for Dialysis Access Management. The modes of failure were predominantly due to external information retrieval errors for ChatGPT-3.5 and logical errors for ChatGPT-4.

Conclusion: ChatGPT-4 outperformed ChatGPT-3.5 on vascular surgery board-style questions yet achieved only moderate accuracy. Version updates did not consistently improve the performance in this specialized domain, emphasizing the complexity of decision-making in vascular surgery and the current limitations of LLMs in surgical education.

Varicose vein procedures are common vascular surgeries. Over the last two decades, the management of saphenous vein reflux has evolved from traditional surgical stripping (SS) to less invasive endovenous therapies (EVTs), including thermal and non-thermal ablation. As a result, EVT is now the preferred approach for treating incompetent saphenous veins. Although all methods demonstrate comparable effectiveness and high closure rates, both SS and EVT have unique advantages and disadvantages. SS ensures the complete removal of refluxing truncal veins but carries the risk of complications related to invasiveness, such as groin infection, lymphatic issues, and nerve damage. EVT is minimally invasive and promotes a quicker recovery and return to work. However, thermal techniques can cause heat-related nerve or skin damage and necessitate tumescent injections, whereas non-thermal approaches may lead to thrombophlebitis or allergic reactions. Thus, the selection of optimal treatment should consider both the anatomical features of the refluxing vein and the specific characteristics of each procedure. This review aims to compare the clinical outcomes of these procedures and propose a suitable decision-making process for selecting the appropriate treatment for incompetent saphenous veins.

Iliofemoral post-thrombotic syndrome may lead to severe venous claudication and leg ulceration. Surgical bypass remains a valuable alternative when endovascular recanalization is unsuccessful. We present a modified Palma procedure using the deep femoral vein (DFV) as an inflow, given the unavailability of the common femoral vein. A 40-year-old man with chronic left leg pain, edema, and ulceration had complete occlusion of the left iliofemoral axis with failed percutaneous attempts. A crossover bypass was performed using the contralateral great saphenous vein, anastomosed end-to-side to the DFV. Postoperatively, pain and edema resolved, and the ulcer healed within 90 days. Duplex ultrasonography at 2 months confirmed graft patency with preserved phasic flow. This technical modification offers a feasible alternative for complex post-thrombotic cases when conventional inflow sites are compromised and may expand surgical options for deep venous reconstruction.

Carotid body paraganglioma (CBP) is a rare neuroendocrine tumor that typically develop at the carotid bifurcation. Although most CBPs are non-functional and slow growing, some pose a risk of local invasion and distant metastasis. Advances in genetic testing have revealed that up to 50% of paragangliomas (PGLs) are linked to germline mutations, most commonly in the succinate dehydrogenase (SDHx) genes. The clinical presentation of CBPs is often subtle, with patients noticing a painless, slowly enlarging mass in the neck. CBP diagnosis often relies on imaging (both anatomical and functional) and biochemical testing. In managing CBPs, surgical resection remains the standard treatment for localized tumor, but the procedure can be technically demanding due to high vascularity and close proximity of the tumor to cervical neurovascular structures. Other treatment options, especially for patients with unresectable or metastatic CBPs, include radiotherapy, radionuclide therapy, and chemotherapy. This review discussed current CBP management, from diagnosis to treatment and surveillance, highlighting the importance of individualized care based on tumor behavior, genetic background, and surgical risk.

Takayasu arteritis (TAK) is a rare form of vasculitis that is more common in young Asian females. TAK is characterized as idiopathic, inflammatory, granulomatous, and large-vessel panarteritis. This review provides a brief summary of the etiology and clinical phase of TAK, its epidemiology in Korea, challenges in diagnosis and treatment, and the outcomes of open versus endovascular therapy. In addition, it outlines the general principles of surgical treatment and provides technical tips for TAK surgery in detail.

Chondroblastic osteosarcoma is a rare and aggressive subtype of osteosarcoma, and thoracic aortic involvement is exceptionally uncommon. We report a 57-year-old male with multifocal metastatic chondroblastic osteosarcoma presenting as a mediastinal mass encasing the descending thoracic aorta. He presented with painful thigh swellings, fatigue, and weight loss for three weeks. His history included right orchidectomy and chemotherapy for a germ cell tumor 30 years earlier, with remission. Biopsy of the thigh lesions confirmed metastatic chondroblastic osteosarcoma. Staging computed tomography revealed an unresectable mediastinal mass encasing the descending thoracic aorta, with intraluminal thrombus causing near-total occlusion. Positron emission tomography-computed tomography demonstrated avidity involving the mediastinal mass and partial uptake in the thrombus. Thoracic endovascular aortic repair relieved the stenosis and enabled systemic therapy. Despite systemic and palliative therapies, the patient succumbed to progressive disease 13 months after diagnosis. This case highlights the role of endovascular repair in malignant aortic involvement.

The great saphenous vein is widely used as a conduit for bypass surgery because of its availability, length, and favorable patency. However, saphenous vein grafts (SVGs) carry the risk of aneurysmal degeneration during the follow-up period in rare cases. We report a 37-year-old man with a suprarenal aortic pseudoaneurysm who underwent hybrid repair with visceral artery debranching using SVGs combined with endovascular stent graft placement. Eight years later, he developed a 44 mm SVG aneurysm and the aneurysmal segment was successfully replaced with a prosthetic graft. This case illustrates the risk of late aneurysmal degeneration in SVGs for hybrid aortic repair and emphasizes the importance of long-term surveillance and timely intervention to prevent rupture.

Renal artery aneurysms (RAAs) are rare and primarily affect elderly patients. They can be caused by connective tissue diseases, arteritis, or infection. However, most RAAs are caused by gradual degenerative changes that weaken the elastic laminae of the arteries. The condition progresses slowly, and it takes time to develop to a size that can cause symptoms. We report a case of RAA in an elderly woman who required surgical treatment. The aneurysm progressed from the normal arterial diameter to 30×25 mm within 10 days after the onset of a urinary tract infection. The patient was successfully treated with aneurysm resection, renal artery bypass, and re-implantation of both renal veins. Rapidly growing renal artery aneurysm may occur after urinary tract infection, and renal vein re-implantation can be a useful option for renal artery aneurysm repair.