European Journal of Vascular and Endovascular Surgery最新文献

Objective: Juxtarenal abdominal aortic aneurysms (JRAAAs) are anatomically complex and technically challenging to treat. Traditional metrics such as mortality or complication rates may not adequately reflect care quality. Composite measures such as failure to rescue (FTR) and textbook outcome (TO) offer a more comprehensive, patient centred assessment, capturing complication management and peri-operative course. TO reflects an ideal post-operative course, and FTR represents the proportion of patients who die after a major complication. This study assessed the feasibility and added value of TO and FTR as quality indicators in elective JRAAA repair using national registry data from the Netherlands and Sweden.

Methods: This retrospective cohort study used prospectively collected data from the Dutch Surgical Aneurysm Audit (DSAA) and the Swedish Swedvasc registry. Patients undergoing elective JRAAA repair with open surgical repair (OSR) or complex endovascular aneurysm repair (cEVAR) between 2016 and 2023 were included. TO reflected an ideal post-operative course; FTR captured death after major complications (Clavien-Dindo ≥ IV). Multivariable logistic regression was used to assess associations between surgical approach and outcomes.

Results: This study included 1 925 patients from the Netherlands and 775 from Sweden. In the Dutch cohort, cEVAR was associated with statistically significantly lower FTR rates (1.6% vs. 4.3%; p < .001), 30 day mortality (2.6% vs. 6.1%; p < .001), severe complications (5.8% vs. 14.8%; p < .001), and higher TO achievement (81.4% vs. 73.6%; p < .001) compared with OSR. No statistically significant differences in FTR (1.6% vs. 1.8%; p = .83) or TO (92.5% vs. 88.4%; p = .086) were found between OSR and cEVAR in the Swedvasc cohort. The main structural difference between the registries was the absence of re-admission data in Swedvasc.

Conclusion: TO and FTR show future promise as standardised metrics to evaluate surgical quality in JRAAA repair. Their added value is conceptual and requires further validation. Registry differences and incomplete data remain limitations. Implementing key variables with standardised definitions will enable benchmarking and support international quality improvement.

Objective: There are no evidence based recommendations for anticoagulation management after venous procedures. This study aimed to evaluate how anticoagulation was managed after venous stenting for deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS).

Methods: Patients with venous stenting for DVT or PTS from May 2006 to November 2021 were screened for inclusion. The primary endpoint was post-interventional management of anticoagulation or antiplatelet therapy. Secondary endpoints were recurrent venous thromboembolism (VTE) and potential risk factors (e.g., thrombophilia and left iliac vein compression syndrome). All patients underwent thrombophilia tests for the study's purpose. Descriptive statistics were applied for anticoagulation management. Recurrent VTE free survival was estimated using Kaplan-Meier methods (log rank). Binary logistic regression was conducted to estimate risk factors for recurrent VTE.

Results: Seventy nine patients were included: 41 DVT and 38 PTS. Until the last follow up (median 250 weeks; quartile [Q]1, Q3: 158, 439), anticoagulation was continued for 57 (72%) and stopped for 22 (28%) patients. Post-interventional recurrent VTE occurred in 30 (38%) patients (32% DVT [n = 13]; 45% PTS [n = 17]) after a median duration of 11 weeks (Q1, Q3: 3, 129), 93% in stent re-thrombosis. Primary patency was 62% (n = 49) and secondary patency was 94% (n = 74). Most recurrent VTEs (86.7%) occurred during anticoagulant therapy. Anticoagulation was re-started in all five patients with recurrent < associated with increased recurrent VTE (odds ratio 3.02, 95% confidence interval 1.13 - 8.07; p = .027) and left iliac vein compression syndrome with decreased recurrent VTE (odds ratio 0.30, 95% confidence interval 0.10 - 0.90; p = .032). Significance was lost in multivariable analysis.

Conclusion: Recurrent VTE occurred in 38% patients (31.7% DVT; 44.7% PTS), almost always (93%) in stent re-thrombosis. Although approximately a quarter of patients experienced VTE after cessation of anticoagulation, stent patency was restored in all cases. No risk factors for recurrent VTE were identified.

Objective: Although sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective treatments, their use may be associated with increased risk of lower limb amputation. Moreover, no studies have reported on their clinical safety and efficacy in patients with chronic limb threatening ischaemia (CLTI). Therefore, this multicentre retrospective observational study evaluated their clinical efficacy in diabetic patients with CLTI who underwent endovascular therapy (EVT).

Methods: Eligible patients with diabetes and CLTI were retrospectively identified between January 2021 and December 2023 from a multicentre Japanese registry of EVT. These patients were divided into two groups based on whether they received treatment with SGLT2 inhibitors. The clinical safety and efficacy of SGLT2 inhibitors was evaluated after propensity score matching (PSM). The primary outcome was freedom from major amputation within 1 year. Secondary endpoints were amputation free survival, all cause mortality, wound healing, cardiovascular mortality, and infection related mortality within 1 year.

Results: Among 257 patients, 51 matched pairs were analysed after PSM, with no baseline differences between groups. One year freedom from major amputation was similar (94.0% vs. 86.8%; p = .30), whereas amputation free survival was statistically significantly higher in the SGLT2 inhibitor group (88.3% vs. 71.3%; p = .030). All cause mortality was also lower with SGLT2 inhibitors (4.7% vs. 18.7%; p = .030). Wound healing (82.8% vs. 69.7%; p = .49), cardiovascular mortality (0.0% vs. 7.0%; p = .070), and infection related mortality (2.2% vs. 6.1%; p = .31) did not differ statistically significantly between the groups.

Conclusion: SGLT2 inhibitors may not be associated with an increased risk of major lower limb amputation in patients with CLTI undergoing EVT. These agents may be associated with improved clinical outcomes in this population.

Objective: The aim of this study was to determine whether patients with ≥ 10 mm aneurysm sac regression are suitable for a less intensive surveillance regimen after endovascular aneurysm repair (EVAR).

Methods: In this retrospective single centre study, all patients who underwent elective standard EVAR between 2004 and 2018 were included. All available follow up imaging was retrospectively assessed, and aneurysm sac diameters were compared with the first post-operative computed tomography angiography. Patients were divided into two groups: patients with < 10 mm aneurysm sac regression and patients with ≥ 10 mm aneurysm sac regression. The primary endpoint was any EVAR related complication, defined as aneurysm rupture, type I or III endoleak, type II endoleak requiring re-intervention, or loss of seal that required intervention.

Results: A total of 263 patients were included in this analysis, of which 166 patients (63.1%) developed ≥ 10 mm aneurysm sac regression in the first 4 years after EVAR. Among the 166 patients who achieved aneurysm sac regression of ≥ 10 mm, 11 (6.6%) developed an EVAR related complication during a median (interquartile range) follow up of 64 (47, 85) months. The estimated 5 year freedom from developing an EVAR related complication after reaching ≥ 10 mm sac regression was 94.4% (95% confidence interval 90.9 - 98.1%). When imaging would be postponed by 2, 3, or 5 years after ≥ 10 mm aneurysm sac regression, a cumulative delay in diagnosis of EVAR related complications would have occurred in two (1.2%), three (1.8%), and five (3.0%) patients, respectively.

Conclusion: Once the aneurysm sac diameter after EVAR had regressed ≥ 10 mm, patients experienced a very low rate of development of EVAR related complications. In these patients, it is safe to increase surveillance intervals.