European Journal of Vascular and Endovascular Surgery最新文献

Objective: This study aimed to evaluate treatment indications, compare therapeutic approaches, and assess outcomes in patients with infrarenal penetrating aortic ulcers (iPAUs).

Methods: This was a retrospective, multicentre, observational study of patients with iPAUs treated between January 2018 and December 2022 across 12 European centres. Treatment strategies included open surgical repair (OSR) and endovascular techniques, including balloon expandable stent grafts (BESGs), covered endovascular reconstruction of the aortic bifurcation (CERAB), and endovascular aortic repair (EVAR) using bifurcated or tube grafts. Primary endpoints were technical success, anatomy dependent graft selection, and safety outcomes.

Results: Among 260 patients (mean age 74.2 years, 77.7% men), 96.9% (n = 252) underwent endovascular repair. PAU size was the primary indication in 70.4% of cases. Bifurcated grafts were used in 64.7% (n = 163) and tube grafts in 35.3% (n = 89). Bifurcated grafts were more frequently selected for patients with larger proximal landing zones (21 ± 3 mm vs. 18 ± 5 mm; p <  .001), wider aortic bifurcation diameters (20 ± 5 mm vs. 18 ± 4 mm; p < .001), shorter PAU to bifurcation distances (30 ± 24 mm vs. 41 ± 33 mm; p = .003), and larger PAU base diameters (median 22 mm [interquartile range 16, 30] vs. 18 mm [interquartile range 12, 25]; p < .001). Although few patients underwent OSR, the group had high technical success and no 30 day deaths. Technical success rates were 97.8% for BESGs, 100% for CERAB, and 99.3% for EVAR. Median hospital stay was four days. Major adverse events occurred in 3.5%, with a 30 day mortality rate of 1.5% and a re-intervention rate of 8.1%. Chronic obstructive pulmonary disease independently predicted 30 day mortality (odds ratio [OR] 4.063; p = .039) and major adverse events (OR 7.181; p = .035). Over a median follow up of 21.2 months, the overall mortality rate was 19.3% (9.4% aortic related), with a re-intervention rate of 9.9% (9.4% aortic related).

Conclusion: Endovascular repair, especially with bifurcated grafts, was the preferred safe approach. CERAB and BESGs were effective in anatomically suitable cases.

Objective: Chronic venous disease (CVD) of the lower extremities is a common health problem, with moderate to severe symptoms such as leg pain and sensation of swelling, and potentially severe complications such as venous ulcers. However, few population based, physician performed duplex ultrasound (DUS) studies on CVD prevalence and associated risk factors exist. This study aimed to assess the prevalence of the different CEAP (Clinical, Etiological, Anatomical, Pathophysiological) clinical classes, CVD CEAP clinical class C3 - C6, and superficial venous reflux in a Dutch population, along with associated risk factors.

Methods: This was a population based, cross sectional cohort study embedded in the Rotterdam Study. Participants aged ≥ 40 years from one Rotterdam district were invited. Baseline demographics, CEAP classification, and DUS outcomes for superficial venous reflux were recorded. Independent risk factors for superficial venous reflux and CVD CEAP clinical class C3 - C6 were identified with multivariable logistic regression analysis.

Results: Of 2 510 participants (1 441 women, 1 069 men; median age 54 years), 83.9% of participants were classified as C0 - C1, 12.7% as C2, 2.3% as C3, and 0.7% as C4 - 6. The prevalence of CVD CEAP clinical class C3 - C6 was 3.0%. Superficial venous reflux was present in 23.7%. Independent risk factors for CVD CEAP C3 - C6 included older age, being a woman, and greater height. Risk factors for superficial venous reflux included older age, being a woman, greater height, and a high waist-hip ratio.

Conclusion: This study showed a prevalence of superficial venous reflux, and of CVP CEAP clinical class C3-C6 of 23.7% and 3.0%, respectively, in a general Dutch population. The identified risk factors enable identification of people at risk and optimisation of preventive measures, which could result in reduced healthcare costs.