European Journal of Vascular and Endovascular Surgery最新文献

英文中文

Sealing Zone Failure Decreases the Long Term Durability of Endovascular Aneurysm Repair 密封区失效会降低血管内动脉瘤修复术的长期耐久性。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.09.007

Charlotte Sandström , Mattias B. Andersson , Marko Bogdanovic , Nina Fattahi , Robert Lundqvist , Manne Andersson , Joy Roy , Rebecka Hultgren , Håkan Roos

Objective

Endovascular aneurysm repair (EVAR) has a higher long term aneurysm related mortality rate compared with open surgery, mainly due to aneurysm rupture. Loss of stent graft to vessel apposition at the EVAR sealing zones is a potential cause of post-EVAR rupture. This study aimed to investigate sealing zone failure and its relationship with post-EVAR rupture.

Methods

This was a retrospective structured review of pre- and post-operative computed tomography (CT) scans of 399 consecutive patients treated with standard bifurcated EVAR. The primary outcome was total loss of seal at last post-operative CT. Secondary outcomes were partial loss of seal, standard follow up detection, post-EVAR rupture, aneurysm sac development, and endoleaks.

Results

During a median follow up of 5.3 years, total and partial loss of seal occurred in 85 (21.3%) and 78 (19.5%) patients, respectively. Initial mean sealing zone lengths were within current recommendations but decreased over time, mainly due to vessel dilatation. Mean proximal sealing length at the one month CT was 15.5 ± 10.5 mm (95% confidence interval [CI] 12.6 – 18.5 mm) in the group with total loss of seal, 14.3 ± 6.9 mm (95% CI 12.2 – 16.4 mm) with partial loss of seal, and 23.2 ± 7.4 mm (95% CI 22.3 – 24.0 mm) with preserved seal through follow up (p < .001). Mean iliac sealing lengths were 22.4 ± 12.1 mm (95% CI 18.9 – 25.8 mm) if total loss and 21.8 ± 10.0 mm (95% CI 19.6 – 24.0 mm) if partial loss of seal vs. 34.7 ± 12.4 mm (95% CI 33.8 – 35.7 mm) if preserved seal. Larger vessel diameters were associated with loss of seal in both the proximal and distal sealing zones. During the study period, 13 post-EVAR ruptures occurred, all preceded by CT findings of total (n = 7) or partial (n = 6) loss of seal. Aneurysm sac expansion was seen in 40% of patients with total loss of seal, 18% with partial loss of seal, and 6.6% with preserved seal.

Conclusion

Loss of seal after EVAR is frequent and associated with post-EVAR rupture. Increased recommended sealing zones lengths and focus on sealing zones in surveillance may reduce post-EVAR ruptures and aneurysm related death.

目的与开放手术相比，血管内动脉瘤修补术（EVAR）与动脉瘤相关的长期死亡率较高，主要原因是动脉瘤破裂。EVAR密封区支架移植物与血管贴合的丧失是导致EVAR术后破裂的潜在原因。本研究旨在调查密封区失效及其与EVAR术后破裂的关系。方法这是一项回顾性结构化研究，对399例连续接受标准分叉EVAR治疗的患者的术前和术后计算机断层扫描（CT）进行回顾性分析。主要结果是术后最后一次 CT 检查时完全失封。结果在中位 5.3 年的随访期间，分别有 85 例（21.3%）和 78 例（19.5%）患者出现完全和部分失封。最初的平均密封区长度符合目前的建议，但随着时间的推移有所减少，这主要是由于血管扩张造成的。在一个月的CT检查中，完全丧失密封性组的近端平均密封长度为15.5 ± 10.5 mm（95% 置信区间 [CI] 12.6 - 18.5 mm），部分丧失密封性组的近端平均密封长度为14.3 ± 6.9 mm（95% 置信区间 [CI] 12.2 - 16.4 mm），通过随访保留密封性组的近端平均密封长度为23.2 ± 7.4 mm（95% 置信区间 [CI] 22.3 - 24.0 mm）（p < .001）。如果完全丧失密封性，平均髂骨密封长度为 22.4 ± 12.1 毫米（95% CI 18.9 - 25.8 毫米）；如果部分丧失密封性，平均髂骨密封长度为 21.8 ± 10.0 毫米（95% CI 19.6 - 24.0 毫米）；如果保留密封性，平均髂骨密封长度为 34.7 ± 12.4 毫米（95% CI 33.8 - 35.7 毫米）。血管直径越大，近端和远端密封区的密封性越差。在研究期间，共发生了 13 例 EVAR 术后破裂，所有破裂前的 CT 检查结果均为完全（7 例）或部分（6 例）失去密封性。在完全丧失密封的患者中，有 40% 出现动脉瘤囊扩张；在部分丧失密封的患者中，有 18% 出现动脉瘤囊扩张；在保留密封的患者中，有 6.6% 出现动脉瘤囊扩张。增加推荐的密封区长度并在监测中重点关注密封区，可减少EVAR术后破裂和动脉瘤相关死亡率。

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引用次数: 0

Short Term Outcomes of a Prospective Registry of Popliteal and Infrapopliteal Endovascular Interventions for Chronic Limb Threatening Ischaemia 腘窝和腘下血管内介入治疗慢性肢体缺血的前瞻性登记的短期效果。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.09.033

Michael J. Nugteren , Constantijn E.V.B. Hazenberg , Olaf J. Bakker , Maarten K. Dinkelman , Bram Fioole , Jan-Willem Hinnen , Maurice Pierie , Gert J. de Borst , Çağdaş Ünlü

Objective

The prevalence of chronic limb threatening ischaemia (CLTI) is increasing worldwide, resulting in the need for more patients to undergo revascularisation, especially for below the knee pathology. Nevertheless, prospective data on below the knee endovascular interventions are lacking. The aim of the study was to provide large scale, real world data on procedural and short term outcomes of popliteal and infrapopliteal endovascular interventions in patients with CLTI.

Methods

This study is an analysis of the first 1 000 interventions of the Dutch Chronic Lower Limb Threatening Ischaemia Registry (THRILLER). It includes all patients with CLTI undergoing popliteal or infrapopliteal endovascular revascularisation in seven hospitals in the Netherlands. The primary outcomes were limb salvage and amputation free survival (AFS) at three months estimated by the Kaplan–Meier method. Secondary outcomes were procedural complications and primary patency.

Results

Between February 2021 and July 2023, 1 000 endovascular procedures were performed in 840 patients (947 limbs), treating 486 popliteal and 1 209 tibial lesions. Wound, Ischaemia, and foot Infection (WIfI) stages 1 – 4 were present in 16.8%, 17.2%, 25.4%, and 40.6% of the limbs, respectively. Technical success was hampered by arterial perforation, acute thrombosis, and distal embolisation in 8.7%, 1.0%, and 2.3% of the interventions, respectively. Limb salvage was 100.0%, 96.9%, 94.9%, and 86.1% (p < .001), whereas AFS was 96.9%, 93.2%, 86.6%, and 76.4% for WIfI stages 1 – 4 at three months (p < .001), respectively. Primary patency at the 6 – 8 week visit was 86.4% for popliteal and 74.3% for tibial lesions, respectively.

Conclusion

THRILLER presents a large prospective database on outcomes of endovascular CLTI interventions. Popliteal and infrapopliteal endovascular revascularisation for CLTI is safe. Interventions with initial technical success have high rates of limb salvage and survival at three months. The WIfI classification provides a reliable instrument to predict limb salvage and AFS independently at three months.

目的：慢性肢体缺血（CLTI）的发病率在全球范围内不断上升，因此需要对更多患者进行血管重建，尤其是膝下病变患者。然而，目前还缺乏膝下血管内介入治疗的前瞻性数据。该研究旨在提供大规模的真实数据，说明腘动脉和膝下动脉血管内介入治疗CLTI患者的程序和短期疗效：本研究是对荷兰慢性下肢危重缺血登记处（THRILLER）前 1000 例介入治疗的分析。研究对象包括在荷兰七家医院接受腘部或腘下血管内再通术的所有慢性下肢危重缺血患者。主要结果是三个月后的肢体挽救率和无截肢存活率（AFS），采用 Kaplan-Meier 法进行估算。次要结果为手术并发症和主要通畅率：结果：2021 年 2 月至 2023 年 7 月期间，为 840 名患者（947 条肢体）实施了 1000 例血管内手术，治疗了 486 例腘动脉病变和 1 209 例胫骨病变。分别有16.8%、17.2%、25.4%和40.6%的肢体出现伤口、缺血和足部感染（WIfI）1-4期。分别有8.7%、1.0%和2.3%的介入手术因动脉穿孔、急性血栓形成和远端栓塞而影响了技术成功率。三个月后，肢体挽救率分别为 100.0%、96.9%、94.9% 和 86.1%（P < .001），而 WIfI 1 - 4 期的 AFS 分别为 96.9%、93.2%、86.6% 和 76.4%（P < .001）。腘窝和胫骨病变在6-8周就诊时的初次通畅率分别为86.4%和74.3%：THRILLER提供了一个大型前瞻性数据库，用于研究CLTI血管内介入治疗的效果。腘窝和胫骨下血管内血运重建治疗CLTI是安全的。最初技术成功的介入治疗具有较高的肢体挽救率和三个月的存活率。WIfI分类法是独立预测三个月后肢体挽救率和AFS的可靠工具。

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引用次数: 0

Conservative Therapy for Patients with Intermittent Claudication: What we See Might Depend Mainly on What we are Looking For 间歇性跛行患者的保守疗法：我们所看到的可能主要取决于我们在寻找什么。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.09.025

Joakim Nordanstig, Karin Ludwigs, Vishal Amlani

引用次数: 0

Dual Antiplatelet Therapy Following Branched or Fenestrated Endovascular Aneurysm Repair Might Be the Best Option 分支或瘘管血管内动脉瘤修复术后的双重抗血小板疗法可能是最佳选择。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.10.027

José Oliveira-Pinto , Christopher P. Twine

引用次数: 0

A Randomised Controlled Trial is Needed to Prove the Efficacy of Venous Arterialisation in Patients with Chronic Limb Threatening Ischaemia 需要进行随机对照试验，以证明静脉动脉化对慢性肢体缺血患者的疗效。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.11.023

Maarit A. Venermo

引用次数: 0

A South African View of the New European Society for Vascular Surgery Vascular Trauma Guidelines 南非对新欧洲血管外科学会血管创伤指南的看法。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.12.034

Pradeep Pravinkumar Mistry, Dirk Andries Le Roux, Ian Roy Grant

引用次数: 0

Employing magnetic resonance histology for precision chronic limb-threatening ischemia treatment planning

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2025.01.008

Judit Csore MD, PhD , Madeline Drake MD , Christof Karmonik PhD , Bright Benfor MD , Peter Osztrogonacz MD , Alan B. Lumsden MD , Trisha L. Roy MD, PhD

引用次数: 0

EJVES vol. 69, issue 2 (February 2025) - Spanish Translated Abstracts

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/S1078-5884(25)00038-3

引用次数: 0

Outcomes after Endovascular Arch Repair in Patients with a Mechanical Aortic Valve: Results from a Multicentre Study 机械主动脉瓣患者血管内弓修复术后的疗效：一项多中心研究的结果

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.09.029

Nikolaos Konstantinou , Tomasz Jakimowicz , Stephan Haulon , Maximilian Pichlmaier , Said Abisi , Luis Mendes Pedro , Adib Khanafer , Nikolaos Tsilimparis

Objective

The aim of this study was to investigate outcomes after endovascular aortic arch repair in patients with a mechanical aortic valve where the valve needs to be crossed.

Methods

An international, multicentre, retrospective observational study was undertaken including all consecutive patients who underwent endovascular arch repair with mechanical aortic valve crossing.

Results

From March 2020 to August 2023, 12 patients were included in the study (median age 55 years, interquartile range 45, 67 years; 58% male). Five patients (42%) had a genetically confirmed connective tissue disorder (CTD) and three more had a high clinical suspicion of CTD. Most patients had a bileaflet valve (11/12; 92%) and one patient had a monoleaflet one. All patients had previously undergone surgical ascending aortic repair. Technical success was 100% with successful completion of the procedure with no valve damage. Two deaths (17%) were observed in the first 30 days post-operatively with no signs of valve malfunction: one patient died of major stroke due to excessive wire and sheath manipulation in the arch; and another due to cardiac arrest of unknown cause, with no valve damage being detected in the autopsy. No intra-operative technical difficulties regarding valve cannulation were observed. During a median follow up of eight months, one patient died fifteen months after the procedure owing to non-aortic related causes, and four endoleaks were present on the latest computed tomography angiography, none type I or III.

Conclusion

Endovascular aortic arch repair in a selected group of patients with a mechanical aortic valve, treated in experienced high volume aortic centres, seems technically feasible and reasonably safe. These preliminary results underline the complexity of the procedure and should be validated by larger cohort studies. With careful patient selection and adequate physician experience, the presence of a mechanical aortic valve could potentially no longer pose a major contraindication to endovascular arch repair in the future.

研究目的本研究旨在调查主动脉瓣机械瓣膜需要跨瓣的患者接受主动脉弓血管内修复术后的效果：方法：开展一项国际性、多中心、回顾性观察研究，纳入所有接受主动脉瓣机械跨瓣的血管内主动脉弓修复术的连续患者：从 2020 年 3 月到 2023 年 8 月，共有 12 名患者被纳入研究（中位年龄 55 岁，四分位数范围 45 至 67 岁；58% 为男性）。五名患者（42%）经基因证实患有结缔组织病（CTD），另有三名患者临床高度怀疑患有CTD。大多数患者使用双叶瓣（11/12；92%），一名患者使用单叶瓣。所有患者之前都接受过升主动脉手术修复。技术成功率为100%，手术顺利完成且无瓣膜损伤。术后前30天内有两名患者死亡（17%），但没有瓣膜故障的迹象：一名患者死于大面积中风，原因是过多的钢丝和鞘在弓部操作；另一名患者死于不明原因的心脏骤停，尸检未发现瓣膜损伤。术中没有发现瓣膜插管方面的技术问题。在中位八个月的随访期间，一名患者在术后十五个月因与主动脉无关的原因死亡，在最新的计算机断层扫描血管造影中发现了四个内漏，但都不是I型或III型：结论：在经验丰富、手术量大的主动脉中心，对选定的一组机械主动脉瓣患者进行主动脉弓血管内修复术在技术上似乎是可行的，而且相当安全。这些初步结果凸显了手术的复杂性，应通过更大规模的队列研究加以验证。只要仔细选择患者，医生有足够的经验，机械性主动脉瓣的存在将来可能不再是血管内主动脉弓修复术的主要禁忌症。

{"title":"Outcomes after Endovascular Arch Repair in Patients with a Mechanical Aortic Valve: Results from a Multicentre Study","authors":"Nikolaos Konstantinou , Tomasz Jakimowicz , Stephan Haulon , Maximilian Pichlmaier , Said Abisi , Luis Mendes Pedro , Adib Khanafer , Nikolaos Tsilimparis","doi":"10.1016/j.ejvs.2024.09.029","DOIUrl":"10.1016/j.ejvs.2024.09.029","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to investigate outcomes after endovascular aortic arch repair in patients with a mechanical aortic valve where the valve needs to be crossed.</div></div><div><h3>Methods</h3><div>An international, multicentre, retrospective observational study was undertaken including all consecutive patients who underwent endovascular arch repair with mechanical aortic valve crossing.</div></div><div><h3>Results</h3><div>From March 2020 to August 2023, 12 patients were included in the study (median age 55 years, interquartile range 45, 67 years; 58% male). Five patients (42%) had a genetically confirmed connective tissue disorder (CTD) and three more had a high clinical suspicion of CTD. Most patients had a bileaflet valve (11/12; 92%) and one patient had a monoleaflet one. All patients had previously undergone surgical ascending aortic repair. Technical success was 100% with successful completion of the procedure with no valve damage. Two deaths (17%) were observed in the first 30 days post-operatively with no signs of valve malfunction: one patient died of major stroke due to excessive wire and sheath manipulation in the arch; and another due to cardiac arrest of unknown cause, with no valve damage being detected in the autopsy. No intra-operative technical difficulties regarding valve cannulation were observed. During a median follow up of eight months, one patient died fifteen months after the procedure owing to non-aortic related causes, and four endoleaks were present on the latest computed tomography angiography, none type I or III.</div></div><div><h3>Conclusion</h3><div>Endovascular aortic arch repair in a selected group of patients with a mechanical aortic valve, treated in experienced high volume aortic centres, seems technically feasible and reasonably safe. These preliminary results underline the complexity of the procedure and should be validated by larger cohort studies. With careful patient selection and adequate physician experience, the presence of a mechanical aortic valve could potentially no longer pose a major contraindication to endovascular arch repair in the future.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 2","pages":"Pages 263-270"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Type II Endoleaks and Aneurysm Sac Growth: Can We Really Crack the Piñata? 2 型动脉内膜剥脱和动脉瘤纤溶腔生长：我们真的能打开皮纳塔吗？

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.ejvs.2024.11.001

Nelson Oliveira , José Oliveira-Pinto

引用次数: 0

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