European Journal of Vascular and Endovascular Surgery最新文献

英文中文

Editor's Choice – Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair 抗血小板疗法在使用穿孔或分支血管内修复术治疗复杂主动脉瘤患者中的作用

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.2024.09.030

Petroula Nana , Konstantinos Spanos , Nikolaos Tsilimparis , Stéphan Haulon , Jonathan Sobocinski , Enrico Gallitto , Nuno Dias , Wolf Eilenberg , Anders Wanhainen , Kevin Mani , Dittmar Böckler , Luca Bertoglio , Carla van Rijswijk , Bijan Modarai , Arne Seternes , Florian K. Enzmann , Athanasios Giannoukas , Mauro Gargiulo , Tilo Kölbel , Miltiadis Matsagkas

Objective

Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after F/B-EVAR in 30 day and follow up outcomes.

Methods

A multicentre retrospective analysis was conducted, including F/B-EVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six months. Primary outcomes were 30 day death, and cardiovascular ischaemic and major haemorrhagic events. Secondary outcomes were survival and target vessel (TV) patency during follow up.

Results

A total of 1 430 patients were included: 955 under SAPT and 475 under DAPT. The 30 day mortality rate was similar (SAPT 2.1% vs. DAPT 1.5%; p = .42). Cardiovascular ischaemic events were lower in the DAPT group (SAPT 11.9% vs. DAPT 8.2%; p = .040), with DAPT being an independent protector for acute mesenteric (p = .009) and lower limb ischaemia (p = .020). No difference was found in 30 day major haemorrhagic events (SAPT 7.5% vs. DAPT 6.3%; p = .40). The mean follow up was 21.8 ± 2.9 months. Cox regression showed no survival confounders, with similar rates between groups (log rank p = .71). DAPT patients enjoyed higher TV patency (SAPT 93.4%, standard error [SE] 0.7% vs. DAPT 97.0%, SE 0.6%; log rank p = .007) at thirty six months. Cox regression revealed B-EVAR as a predictor of worse TV patency (hazard ratio 2.03, 95% confidence interval 1.36 – 3.03; p < .001). DAPT was related to higher patency within B-EVAR patients (SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p < .001).

Conclusion

DAPT after F/B-EVAR was associated with lower risk of cardiovascular ischaemic events and higher TV patency, especially in B-EVAR cases. No difference in major haemorrhagic events was observed at 30 days.

目的：尽管带瓣/带支主动脉瓣修复术（f/bEVAR）的数量不断增加，但缺乏术后抗血小板治疗的证据。本研究旨在探讨单抗血小板疗法（SAPT）与双抗血小板疗法（DAPT）在 f/bEVAR 术后 30 天和随访结果中的作用：进行了一项多中心回顾性分析，包括2018年1月1日至2022年12月31日期间接受治疗的f/bEVAR患者。比较结果根据术后抗血小板治疗进行评估。队列分为 SAPT 组（乙酰水杨酸 [ASA] 或氯吡格雷）和 DAPT 组（ASA 和氯吡格雷）。SAPT 或 DAPT 的持续时间为一至六个月。主要结果为30天死亡、心血管缺血性和大出血事件。次要结果是随访期间的存活率和靶血管（TV）通畅率：共纳入 1 430 名患者：结果：共纳入了 1 430 名患者：955 名接受 SAPT 治疗，475 名接受 DAPT 治疗。30天死亡率相似（SAPT为2.1%，DAPT为1.5%；P = .42）。DAPT组的心血管缺血事件较少（SAPT 11.9% vs. DAPT 8.2%; p = .040），DAPT对急性肠系膜缺血（p = .009）和下肢缺血（p = .020）具有独立的保护作用。在 30 天的大出血事件中没有发现差异（SAPT 7.5% 对 DAPT 6.3%；p = .40）。平均随访时间为 21.8±2.9 个月。Cox 回归结果显示，各组之间的生存率相似（对数秩 p = .71），没有共同因素。DAPT患者在36个月时的TV通畅率更高（SAPT 93.4%, 标准误差 [SE] 0.7% vs. DAPT 96.6%, 标准误差 0.7%; log rank p = .007）。Cox 回归显示，bEVAR 是预测电视通畅率降低的一个因素（危险比 2.03，95% 置信区间 1.36 - 3.03；p < .001）。DAPT与bEVAR患者较高的通畅率有关（SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p < .001）：F/BEVAR术后DAPT与较低的心血管缺血性事件风险和较高的TV通畅率相关，尤其是在BEVAR病例中。30天后观察到的大出血事件没有差异。

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引用次数: 0

New Territory Unlocked: Crossing the Mechanical Aortic Valve During Endovascular Aortic Arch Repair 开辟新领域：在血管内主动脉弓修复术中穿越机械主动脉瓣。

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.2024.10.007

Peter Legeza, Kevin Mani

引用次数: 0

Disease-specific patient-reported quality of life after fenestrated/branched endovascular aortic aneurysm repair

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.2025.01.007

Andrew W. Hoel MD , Tanvi Nayak BA , Aravind S. Ponukumati MD , Neel A. Mansukhani MD , David H. Stone MD , David P. Kuwayama MD , Brian Nolan MD MS , Bjoern D. Suckow MD MS

引用次数: 0

Staring at the Future, Looking for the Bigger Picture. 凝视未来，放眼全局。

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.2025.01.039

Stavros K Kakkos, Chrysanthi P Papageorgopoulou

引用次数: 0

Conservative Therapy for Patients with Intermittent Claudication: Primum Non Nocere 间歇性跛行患者的保守疗法：慎重起见

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.2024.09.026

Luca DiMarzo , Monica Campagnol , Antonio V. Sterpetti

引用次数: 0

Open Surgical Repair of a 30 mm Pancreatoduodenal Artery Aneurysm 开腹手术修复 30 毫米胰十二指肠动脉瘤。

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.2024.10.036

Henrique Guedes da Rocha, Carolina Vaz

引用次数: 0

Editor's Choice – Short and Midterm Outcomes of Percutaneous Deep Venous Arterialisation for No Option Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis 经皮深静脉动脉化术治疗无选择性慢性肢体缺血的短期和中期疗效：系统回顾与元分析》。

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.2024.08.001

Junji Tsukagoshi , Martin Orrukem , Junichi Shimamura , Eric A. Secemsky , Tatsuya Nakama , Yujiro Yokoyama , Hisato Takagi , Toshiki Kuno

Objective

Percutaneous deep venous arterialisation (pDVA) is a state of the art technique for treating patients with chronic limb threatening ischaemia (CLTI) with no conventional option for revascularisation. There are limited large scale data examining the clinical effectiveness of pDVA for patients with end stage CLTI.

Data Sources

MEDLINE, Embase, Google Scholar, and Cochrane databases.

Review Methods

Four databases were searched from January 2018 to June 2024 to identify studies investigating the feasibility and clinical outcomes of pDVA for patients with CLTI with no conventional revascularisation options. Meta-analysis of time to event outcomes (mean ± standard deviation) was performed for amputation free survival as the primary outcome, and freedom from amputation and overall survival as secondary outcomes. Other secondary outcomes (mean and 95% confidence interval [CI]) were procedural success rate, patency, re-intervention, and complete wound healing.

Results

Ten non-randomised studies were included with 351 patients. The mean patient age was 70.3 years, and 67.6% were male. Most procedures used the posterior tibial artery. The aggregated rate of amputation free survival at six and twelve months (five studies, 260 patients) was 72.6 ± 2.8% and 66.0 ± 3.1%, respectively, while the overall survival at six and twelve months (five studies, 260 patients) was 85.0 ± 2.3% and 77.7 ± 2.9%, respectively. The procedural success rate (nine studies, 330 patients) was 95.5% (95% CI 92.4 – 98.7%). Primary and secondary patency at six months (four studies, 241 patients) was 23.4% (95% CI 13.6 – 33.2%) and 54.9% (95% CI 34.3 – 75.5%), respectively. The rates of re-intervention (four studies, 190 patients) and complete wound healing (five studies, 190 patients) at twelve months were 41.7% (95% CI 25.7 – 57.7%) and 46.0% (95% CI 31.7 – 60.3%), respectively.

Conclusion

This meta-analysis demonstrated acceptable feasibility for no option CLTI at highly specialised institutions for patients undergoing pDVA. Meta-analysis of time to event outcomes revealed that pDVA provides reasonable amputation free survival for up to twelve months, albeit with a overall low certainty of evidence. Wider adoption of pDVA may be considered in selected patients with CLTI, although its clinical impact and cost effectiveness require further evaluation.

目的：经皮深静脉动脉化术（pDVA）是目前治疗慢性肢体缺血（CLTI）患者的最先进技术，但传统的血管再通术并不适用。目前研究 pDVA 对终末期 CLTI 患者临床疗效的大规模数据还很有限：数据来源：MEDLINE、Embase、Google Scholar 和 Cochrane 数据库：从2018年1月到2024年6月，对四个数据库进行了检索，以确定调查pDVA对无常规血管重建方案的CLTI患者的可行性和临床效果的研究。以无截肢生存期为主要结果，无截肢和总生存期为次要结果，对事件发生时间结果（平均值±标准差）进行了元分析。其他次要结果（平均值和 95% 置信区间 [CI]）包括手术成功率、通畅率、再介入率和伤口完全愈合率：结果：共纳入 10 项非随机研究，351 名患者。患者平均年龄为 70.3 岁，67.6% 为男性。大多数手术使用胫后动脉。6个月和12个月的无截肢存活率（5项研究，260名患者）分别为72.6±2.8%和66.0±3.1%，6个月和12个月的总存活率（5项研究，260名患者）分别为85.0±2.3%和77.7±2.9%。手术成功率（9 项研究，330 名患者）为 95.5%（95% CI 92.4 - 98.7%）。6个月时的一次和二次通畅率（4项研究，241名患者）分别为23.4%（95% CI 13.6 - 33.2%）和54.9%（95% CI 34.3 - 75.5%）。在6个月和12个月时，再次干预率（4项研究，190名患者）和伤口完全愈合率（7项研究，266名患者）分别为：再次干预率15.5%（95% CI 1.4 - 29.6%）和41.7%（95% CI 25.7 - 57.7%），伤口愈合率19.3%（95% CI 9.6 - 29.0%）和46.0%（95% CI 31.7 - 60.3%）：这项荟萃分析表明，在高度专业化的机构中，对接受 pDVA 的患者进行无选择 CLTI 是可行的。对事件发生时间结果的荟萃分析表明，pDVA可提供长达12个月的合理无截肢生存期，尽管证据的确定性总体较低。可以考虑在选择性 CLTI 患者中更广泛地采用 pDVA，但其临床影响和成本效益还需要进一步评估。

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引用次数: 0

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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.2024.10.001

Nabil Chakfé , Anne Lejay

引用次数: 0

Beyond Balloons: What Can We Learn from the TRANSCEND Study?

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

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Pub Date : 2025-01-31 DOI: 10.1016/j.ejvs.2025.01.041

Jean-Baptiste Ricco, Aurélien Hostalrich

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Varicography Guided Foam Sclerotherapy for Symptomatic Extra-Pelvic Varices Originating from Clitoris Pelvic Escape Point.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.ejvs.2025.01.043

Tri-Thuc Nguyen, Phong T Le

引用次数: 0

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