European Journal of Vascular and Endovascular Surgery最新文献

Objectives: To evaluate clinical outcomes and duplex ultrasound changes following venous arterialisation (VA) in patients with no option chronic limb threatening ischaemia (CLTI).

Methods: A retrospective analysis was conducted on 23 patients with no option CLTI who underwent VA procedures with standardised pedal duplex ultrasound assessments at baseline, one week, three months, and six months. Pedal venous maturation (PVM) was defined as the presence of dilated terminal pedal veins with colour Doppler signal and arterialised waveforms. PVM was correlated with VA patency, wound healing, and amputation free survival.

Results: At six months, amputation free survival was 85%; three patients underwent below the knee amputation and one was lost to follow up. PVM developed in the lateral plantar vein of 62% (19 of 22) of patients at a mean of 112.5 ± 60.6 days (range, 5 - 225 days). Once present, PVM persisted in 100% (19 of 19) of cases, including ten patients with VA occlusion. Wound healing occurred in 86% (19 of 22) of patients, including 100% (19 of 19) of those with PVM (p < .001). Healing was minor in 14% and major in 73%. All three patients who ultimately required amputation (at a mean of 152.7 ± 7 days) failed to achieve PVM. In contrast, 100% of patients with PVM remained amputation free at six months (p < .001).

Conclusion: PVM strongly correlated with wound healing and limb preservation following VA in patients with no option CLTI. PVM may serve as a physiological marker for successful revascularisation and guide postprocedure surveillance strategies.

Objective: To report peri-operative and midterm outcomes following open surgical, endovascular, and hybrid revascularisation for acute lower limb ischaemia (ALLI) using contemporary techniques and to provide adjusted comparative analyses accounting for key baseline differences.

Methods: This was a multicentre, retrospective study including patients treated for ALLI (January 2016 - November 2024) across 20 international vascular centres. Patients underwent open surgery (56%), endovascular treatment (20%), or hybrid procedures (24%). Primary outcome was major amputation and or death at the latest follow up. Secondary outcomes included peri-operative mortality, amputation, acute kidney injury, and re-intervention. Multivariable Cox regression analyses adjusted for age, sex, Rutherford stage, and chronic kidney disease were performed. A Fine-Gray competing risk model accounted for death as a competing event for major amputation.

Results: A total of 1 259 patients (51% men; mean age 72 ± 14 years; no popliteal aneurysms) from 19 European centres and one centre in New Zealand were included. At 30 days, peri-operative mortality was 11% (open 12%, endovascular 3%, hybrid 7%; p = .04), and major amputation occurred in 9% (open 10%, endovascular 8%, hybrid 7%; p = .41). Median follow up was 36 months (range 8 - 49 months). At 3 years, estimated mortality was 22.9% (standard error [SE] 1.5%) after open, 11.5% (SE 1.9%) after endovascular, and 19.6% (SE 2.2%) after hybrid procedures. Adjusted analyses demonstrated that endovascular treatment was associated with a lower risk of the composite outcome of major amputation and or death compared with open surgery (hazard ratio 0.69, 95% confidence interval [CI] 0.53 - 0.89; p = .005). For major amputation, the Fine-Gray competing risk analysis showed a reduced subdistribution hazard with endovascular treatment (subdistribution hazard ratio 0.71, 95% CI 0.33 - 0.99; p = .006).

Conclusion: Endovascular ALLI intervention was associated with lower long term amputation risk compared with open surgery, with comparable survival. These findings support endovascular treatment as a safe alternative in patients with ALLI.

Objective: Peripheral arterial disease (PAD) is rising globally, impacting healthcare systems. However, in Hungary, and indeed in the Central Eastern European region, which represents an important historical and socioeconomic block, little is known about recent evolution of this disease and the accompanying therapeutic interventions. This study investigated trends over the past decade among patients with PAD in Hungary, focusing on patients with intermittent claudication (IC) and chronic limb threatening ischaemia (CLTI) undergoing revascularisation.

Methods: Data for patients undergoing revascularisation for IC or CLTI were extracted from the Hungarian Vascular Registry (HUNVASC) from 2011 to 2019 and analysed. Patients were grouped into three time periods: period 1 (2011 - 2013), period 2 (2014 - 2016), period 3 (2017 - 2019) for comparison of characteristics, interventions, and clinical outcomes. In hospital death was the primary outcome of interest.

Results: Among 28 587 patients with PAD undergoing revascularisation, IC accounted for 16 908 and CLTI for 11 679 cases. From period 1 to period 3, the proportion of revascularised IC patients increased from 55.2% to 61.6%, while CLTI decreased from 44.8% to 38.4%. There was a general increase in disease burden over time, and patients with CLTI presented with more comorbidities than those with IC. Endovascular procedures were more common in IC. Open interventions declined from 77.6% to 60.0% with a concomitant rise in endovascular and hybrid methods. The in hospital mortality rate remained consistent at 1.4% and did not change considerably with time. Predictors of mortality included CLTI, ischaemic heart disease, chronic kidney disease, chronic pulmonary disease, older age, and open revascularisation.

Conclusion: This study showed that patients with CLTI had a higher comorbidity burden and higher rates of open interventions and post-operative complications compared with patients with IC. Although open procedures are declining, it remains the primary method of revascularisation irrespective of the disease cohort. Despite increasing patient comorbidities over time, post-operative mortality rates have not changed significantly.

Objective: This study aimed to evaluate early outcomes of endovascular aortic arch repair using custom made stent grafts in patients with a native ascending aortic diameter > 38 mm.

Methods: This two centre, retrospective observational study included all consecutive patients who underwent endovascular arch repair with custom made arch branched stent grafts for a native ascending aorta diameter > 38 mm.

Results: From July 2018 to April 2025, 211 patients were treated with an arch branch device, 25 of these patients (median age 68.88 years; 68% men) with native ascending aorta diameter > 38 mm (mean 41.28 ± 2.94 mm) (14% of total cohort) underwent endovascular arch repair for thoracic aortic aneurysm (n = 19, 76%), aortic dissection (n = 3, 12%), or penetrating ulcer (n = 3, 12%). Nine procedures (36%) were performed under urgent conditions. The mean proximal oversizing was 13%. Technical success was achieved in 96%, with one intra-operative death caused by retrograde type A dissection. No intra-operative stroke or type I/III endoleak was observed. Within 30 days, major and minor strokes occurred in 8% (n = 2) and 12% (n = 3) of patients, respectively. Spinal cord ischaemia and retrograde type A dissection were each observed in three cases. The 30 day mortality rate was 40% (elective 24%, n = 6; urgent 16%, n = 4). Aortic related deaths included retrograde type A dissection (n = 3) and cardiac tamponade (n = 2). Myocardial infarctions (n = 2) were also observed. Additional deaths were attributed to stroke, pulmonary embolism, or unknown causes. Most deaths occurred within the first post-operative week.

Conclusion: Endovascular arch repair using custom made branched endografts in patients with a dilated native ascending aorta (> 38 mm) is technically feasible but often performed in urgent settings and associated with substantial early morbidity and mortality. These findings underscore the importance of careful patient selection, meticulous planning, and performance in experienced aortic centres where open repair should be considered when feasible. Continued device optimisation is essential before wider clinical application.