European Journal of Vascular and Endovascular Surgery最新文献

Objective: The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular trauma with the aim of assisting physicians in selecting the optimal management strategy.

Methods: The guidelines are based on scientific evidence completed with expert opinion. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to the ESVS evidence grading system, where the strength (class) of each recommendation is graded from I to III, and the letters A to C mark the level of evidence.

Results: A total of 105 recommendations have been issued on the following topics: general principles for vascular trauma care and resuscitation including technical skill sets, bleeding control and restoration of perfusion, graft materials, and imaging; management of vascular trauma in the neck, thoracic aorta and thoracic outlet, abdomen, and upper and lower extremities; post-operative considerations after vascular trauma; and paediatric vascular trauma. In addition, unresolved vascular trauma issues and the patients' perspectives are discussed.

Conclusion: The ESVS clinical practice guidelines provide the most comprehensive, up to date, evidence based advice to clinicians on the management of vascular trauma.

Objective: Half of re-interventions after fenestrated and branched endovascular aortic repair (FB-EVAR) are target vessel related. Regarding bridging stent choice, existing data are controversial. This meta-analysis aimed to evaluate the performance of Advanta V12/iCAST as bridging stent in FB-EVAR.

Data sources: The English medical literature was searched through MEDLINE, Embase (via Ovid), and Cochrane databases (end date 15 April 2024).

Review methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PICO (Patient; Intervention; Comparison; Outcome) model were followed. A predefined protocol was registered to PROSPERO (CRD42024556603). Randomised controlled trials and observational studies (2010 - 2024) reporting on Advanta V12/iCAST related target vessel outcomes were eligible. Risk of bias was assessed using ROBINS-I, and evidence quality was assessed via Grading of Recommendations Assessment, Development and Evaluations (GRADE). Primary outcomes were freedom from instability, stenosis and or occlusion, endoleak type Ic and IIIc, and re-intervention of target vessels bridged with the Advanta V12/iCAST. Prevalence and regression meta-analysis were performed.

Results: From 1 439 articles, ten retrospective studies (7 525 target vessels; 3 890 target vessels bridged with Advanta V12/iCAST) were included. According to ROBINS-I, no study was of high quality. Mean follow up was 24.3 (95% confidence interval [CI] 23.9 - 24.7) months. Freedom from instability, stenosis and or occlusion, and endoleak type Ic and IIIc were 94% (95% CI 91 - 96%; p < .010; I² = 91%; GRADE certainty, very low), 97% (95% CI 96 - 98%; p =  .070, I² = 44%; GRADE certainty, low), and 97% (95% CI 94 - 98%; p < .010; I² = 81%; GRADE certainty, very low), respectively. Freedom from target vessel re-intervention was 95% (95% CI 92 - 97%; p < .010; I² = 85%; GRADE certainty, very low). Four studies provided extractable data on Advanta V12/iCAST in fenestrations and four in branches. No difference was detected in freedom from instability (p = .47), stenosis and or occlusion (p = .36), and endoleak type Ic and IIIc (p = .90). Freedom from re-intervention was 93% (95% CI 87 - 96%; p < .010; I² = 90%) in fenestrations and 95% (95% CI 91 - 97%; p = .060, I² = 64%) in branches.

Conclusion: Advanta V12/iCAST bridging stent showed high freedom from target vessel instability, stenosis and or occlusion, and endoleak. Freedom from re-intervention was 95%, being similarly high in fenestrations and branches.

Objective: Inflammation seems to be crucial in the pathogenesis of abdominal aortic aneurysm (AAA). Previous research links inflammatory biomarkers, such as high sensitivity C-reactive protein (HS-CRP), to AAA. Few studies, however, have used a prospective design. The aim of this study was to examine whether individuals with elevated HS-CRP have increased risk of AAA, using a prospective and population based design.

Methods: This prospective, population based, cohort study included 46 322 participants in the Trøndelag Health Study (HUNT) in Norway (53.7% women). During a median follow up time of 12.6 years (range 0 - 26 years), 407 individuals were diagnosed with AAA (28.8% women). Cox proportional hazard regression was applied to examine associations between HS-CRP and risk of AAA. HS-CRP was treated either as a continuous or a categorical variable (dichotomised at 2 mg/L, 1 mg/L, median (1.2 mg/L), or as quartiles).

Results: The hazard ratio (HR) of developing AAA per 1 mg/L increase in HS-CRP (continuous HS-CRP) was 1.02 (95% CI 1.01 - 1.03) in the analysis adjusted for smoking, coronary heart disease, hypertension, diabetes, body mass index, and total cholesterol. Individuals with HS-CRP 2 mg/L or above had almost twice the risk of AAA compared with individuals with HS-CRP less than 2 mg/L (adjusted HR 1.84; 95% CI 1.51 - 2.25). Dichotomising HS-CRP at a clinical cut off point of 1 mg/L (adjusted HR 2.13, 95% CI 1.64 -2.76), or at the median of 1.2 mg/L (adjusted HR 2.12, 95% CI 1.62 - 2.76), slightly strengthened the HR. The adjusted HR gradually increased through the ordered HS-CRP quartiles, and was almost four times higher (HR 3.87, 95% CI 2.54 - 5.92) in the highest HS-CRP quartile (HS-CRP > 2.7 mg/L) compared with the lowest quartile (HS-CRP ≤ 0.6 mg/L).

Conclusion: Individuals with elevated HS-CRP had significantly increased risk of developing AAA.