European Journal of Vascular and Endovascular Surgery最新文献

Objective: Retrograde branches have been used during complex endovascular aortic repair, but their outcomes have not been reported. This study evaluated the retrograde branch performance for renovisceral and other aortic side branches at 30 days and during follow up.

Methods: A multicentre retrospective study (Universität Regensburg; Protocol: 24-3786-101) was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines among centres in Europe, the USA, and New Zealand encompassing patients managed from 1 January 2013 to 31 January 2025. Consecutive patients with thoraco-abdominal and complex abdominal aortic pathologies managed with patient specific company manufactured devices (CMDs) or physician modified endografts (PMEGs) incorporating at least one retrograde branch were included. Technical success, 30 day primary patency, target vessel instability, and re-intervention were analysed. Follow up outcomes were assessed (Kaplan-Meier estimates).

Results: A total of 146 patients were included (72.6% men; age 70.6 ± 2.0 years); 25.3% were managed urgently. Twenty one (14.4%) aneurysms were juxtarenal, 14 (9.6%) were pararenal, and 111 (76.0%) were thoraco-abdominal (38 [26.0%] chronic dissections). One hundred and nine (74.7%) CMDs and 37 PMEGs were implanted, with 575 target vessels; 176 were targeted through a retrograde branch (nine superior mesenteric arteries, 25 coeliac trunks, 118 renal arteries, and 24 other side branches). One hundred (56.8%) of these vessels were bridged with balloon expandable, 46 (26.1%) with self expanding, and 27 (18.5%) with a combination of both covered stent types. The retrograde branch associated technical success was 97.7%. The 30 day primary patency was 97.7% and the re-intervention rate was 1.7%. The mean follow up duration was 21.5 ± 4.8 months. The primary patency and freedom from instability were 81.0 ± 5.7% and 78.2 ± 5.7% at 48 months. The freedom from re-intervention was 92.9 ± 2.5% at 12 months, without further re-intervention during follow up. There was no difference between 6 mm and 8 mm branches or between CMDs and. PMEGs.

Conclusion: Retrograde branches for bridging well selected renovisceral arteries and other aortic side branches were related to high technical success and good patency during midterm follow up.

Objective: Fenestrated endovascular aortic repair (FEVAR) has been proposed as an alternative to open surgical repair (OSR) in complex aortic cases. Target vessel outcomes have shown good results, with re-interventions constituting an important FEVAR pitfall. This single centre, retrospective observational cohort study presented the target vessel outcomes in patients treated with FEVAR in a high volume aortic centre.

Methods: Consecutive patients managed with custom made FEVAR from 2010 to 2024 were included. Vessels targeted through scallops or intentionally unstented fenestrations were excluded from the main analysis. Primary outcomes were target vessel technical success and primary patency, along with freedom from target vessel instability (TVI), endoleak, and re-intervention during follow up, all assessed using Kaplan-Meier estimates. Regression analyses were performed.

Results: The study included 340 patients and 1 181 target vessels. Technical success was 99.2%. The mean follow up was 41.5 ± 32 months. Freedom from TVI was 87.7% (standard error [SE] 1.6%) at 60 months. Previous endovascular aortic repair (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.18 - 3.87; p = .012) and thoraco-abdominal aortic aneurysm (TAAA) (HR 3.3, 95% CI 2.07 - 5.25; p < .001) were independently related to instability. Primary patency was 97.2% (SE 0.7%) at 60 months and was negatively associated with Lifestream use (HR 3.61, 95% CI 1.26 - 8.67; p = .019), while the presence of aortic dissection (HR 0.14, 95% CI 0.001 - 0.98; p = .047) was a positive prognostic factor. Freedom from target vessel endoleak was 90.4% (SE 1.5%) at 60 months. Endoleaks were associated with previous OSR (HR 2.59, 95% CI 1.20 - 5.59; p = .016), number of fenestrations/device (HR 1.69, 95% CI 1.06 - 2.71; p = .029), and TAAA (HR 3.66, 95% CI 2.10 - 6.38; p < .001). Freedom from re-intervention at 60 months was 88.5% (SE 1.6%); only TAAA presence was associated with re-interventions (HR 3.43, 95% CI 2.12 - 5.54; p < .001).

Conclusion: Target vessel performance in FEVAR demonstrated high long term freedom from adverse events, highlighting the effectiveness of the technique. TAAA was found to negatively affect outcomes, as well as previous open or endovascular abdominal aortic procedures.

Objective: The primary objective was to observe how vascular physicians diagnose peripheral arterial disease (PAD) in patients with venous leg ulcers (VLUs) and the type of compression used in patients presenting VLU-PAD without critical limb threatening ischaemia (CLTI). Secondary objectives were to assess the safety and efficacy of compression.

Methods: This was a prospective multicentre survey of physician practices completed by a prospective patient cohort study with a 6 month follow up. Data were collected on VLU-PAD diagnosis and management by physicians, patient and ulcer characteristics, PAD assessment, types of compression used, and compression efficacy and safety.

Results: Twenty-two physicians participated, and 141 patients presenting VLU-PAD without CLTI were included (median age 82 years, median wound duration 18 weeks). PAD was diagnosed by colour Doppler ultrasound (97%) and or toe blood pressure (TBP) (63%). Multilayer bandages were used predominantly (57%), regardless of TBP level. In total, 127 patients completed the 6 month follow up, two were lost to follow up and 12 died (of causes unrelated to compression). Ulcer healing rate was 46% (38% for 30 mmHg ≤ TBP < 60 mmHg, 63% for 60 mmHg ≤ TBP < 80 mmHg, and 78% for TBP ≥ 80 mmHg). Three patients underwent revascularisation for ischaemia unrelated to compression. Among factors associated with healing, TBP ≥ 60 mmHg and ulcer surface area outperformed ulcer duration and waveform analysis in multivariate analysis.

Conclusion: PAD was mainly diagnosed by colour Doppler ultrasound. Compression was not systematically adapted to PAD severity. No compression related adverse event occurred during follow up. TBP emerged as a potential prognostic factor for healing under compression, but this needs to be confirmed in future studies.

Objective: The Wound, Ischemia, and foot Infection (WIfI) staging system for chronic limb threatening ischaemia (CLTI) predicts outcomes after revascularisation, but individual components of WIfI have not been evaluated. This study was designed to evaluate changes in WIfI ischaemia grade as a predictor of major amputation after open and endovascular revascularisation in the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.

Methods: A secondary analysis was conducted of patients with CLTI randomised to surgical bypass or endovascular therapy as part of the BEST-CLI trial with available WIfI ischaemia scores at baseline and 1 month post-procedure. Risk adjusted Cox regression models were used to assess the effect of change in WIfI ischaemia grade on the rate of major amputation, while controlling for potential confounders.

Results: Among 785 patients with CLTI who underwent revascularisation and were alive at 1 year, 629 (80.1%) achieved improvement in their WIfI ischaemia grade within 30 days after undergoing surgical and endovascular interventions. Patients with improved ischaemia grade were younger and were more likely to smoke, have lower baseline ankle brachial indices, and have worse overall WIfI stage at time of revascularisation compared with patients with worsening or no improvement in limb perfusion (p < .050 for all comparisons). Major amputation incidence at 1 year was 14% and was increased among those with higher baseline WIfI stage (3/4 vs. 1/2) and with unchanged or worse WIfI ischaemia grade after revascularisation. Patients with improved WIfI ischaemia grade early after revascularisation had a statistically significantly lower likelihood of major amputation at 1 year (hazard ratio 0.27, 95% confidence interval 0.18 - 0.41; p < .001) after risk adjustment.

Conclusion: Achieving early improvement in limb perfusion based on WIfI ischaemia grade predicts major amputation following revascularisation independent of other risk factors. Changes in ischaemia grade after interventions should be closely monitored to determine the adequacy of revascularisation, risk of CLTI progression, and need for major amputation.