Annals of vascular surgery. Brief reports and innovations最新文献

英文中文

Recurrent disconnection of Gore Iliac Branch Endoprosthesis: Case report and review of contributing factors 戈尔髂支假体复发性断连：病例报告及影响因素回顾

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-20 DOI: 10.1016/j.avsurg.2025.100363

Catherine Boudreau, Caroline Caradu, Xavier Bérard, Eric Ducasse

Introduction

Iliac artery aneurysms (IAAs) which may coexist with abdominal aortic aneurysms (AAAs) or appear as isolated lesions, represent around 2 % of intra-abdominal aneurysms. Endovascular repair using iliac branch devices (IBDs) helps preserve internal iliac artery (IIA) perfusion, reducing complications like buttock claudication. However, device displacement and type III endoleaks are significant challenges, especially in tortuous anatomy.

Report

We report two cases of type III endoleak due to displacement of Gore Iliac Branch Endoprosthesis (IBE). In the first case, a 60-year-old male with a left IAA experienced immediate postoperative IBE migration and type III endoleak, necessitating urgent reintervention with bridging stents. In the second, a 74-year-old male treated for a right IAA had recurrent IBE displacements over four years, with repeated type III endoleaks, managed by repeated stenting. Severe iliac tortuosity contributed to both cases.

Discussion

These cases highlight the complexities of IAA endovascular repair with IBDs, particularly the risk of device migration and endoleaks, with severe iliac tortuosity, device properties (e.g. conformability, low friction coefficient), and response to cardiac pulsatility increasing migration risk. Future studies should address these challenges, focusing on device design improvements and predictive imaging techniques, including artificial intelligence, to enhance long-term outcomes in IAA repair.

髂动脉动脉瘤（IAAs）可与腹主动脉瘤（AAAs）共存或表现为孤立病变，约占腹内动脉瘤的2%。使用髂分支装置（IBDs）进行血管内修复有助于保持髂内动脉（IIA）灌注，减少臀部跛行等并发症。然而，设备移位和III型内漏是一个重大挑战，特别是在弯曲的解剖中。我们报告2例III型内漏，原因是戈尔髂分支内假体移位。在第一例病例中，一名60岁男性左侧IAA患者术后立即发生IBE迁移和III型内漏，需要紧急再次介入搭桥支架。在第二例中，一名74岁的男性因右侧IAA接受治疗，在四年多的时间里反复出现IBE移位，反复出现III型内陷，通过反复支架置入治疗。严重的髂扭转导致了这两个病例。这些病例强调了ibd患者IAA血管内修复的复杂性，特别是器械迁移和内漏的风险，严重的髂弯曲、器械特性（如相容性、低摩擦系数）和对心脏搏动的反应增加了迁移风险。未来的研究应该解决这些挑战，专注于设备设计改进和预测成像技术，包括人工智能，以提高IAA修复的长期效果。

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引用次数: 0

Endovascular coil embolization of a symptomatic profunda femoris artery aneurysm in a patient with a complex vascular history through a transbrachial approach 经肱动脉入路栓塞症状性股深动脉瘤1例

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-19 DOI: 10.1016/j.avsurg.2025.100364

W.M. Yu , D.K. Shan , S.M. Saravitz , N. Udgiri

Profunda femoris artery (PFA) aneurysms, though rare, pose significant risks if untreated. Guidelines predominantly address femoral artery aneurysms as a whole, leaving gaps in management of PFA aneurysms. We present a case of a 65-year-old male with a ruptured 4.6 cm x 7.6 cm x 5.0 cm distal PFA aneurysm alongside proximal PFA and CFA aneurysms. Endovascular coil embolization successfully treated the aneurysm, with concurrent thigh fasciotomy for compartment syndrome. The patient's complex medical history influenced treatment selection. This underscores the importance of early recognition and tailored management, advocating for endovascular interventions in high-risk patients. Further research is imperative to establish consensus guidelines for optimal management of PFA aneurysms.

股深动脉（PFA）动脉瘤虽然罕见，但如果不治疗，会造成很大的风险。指南主要针对整个股动脉动脉瘤，在PFA动脉瘤的处理上留下空白。我们报告一例65岁男性，远端PFA动脉瘤与近端PFA和CFA动脉瘤同时破裂，长4.6 cm x 7.6 cm x 5.0 cm。血管内线圈栓塞成功治疗动脉瘤，同时大腿筋膜切开术治疗隔室综合征。患者复杂的病史影响了治疗的选择。这强调了早期识别和量身定制管理的重要性，提倡对高危患者进行血管内干预。进一步的研究对于建立最佳治疗PFA动脉瘤的共识指南是必要的。

引用次数: 0

Surgical extremity preservation in severe acute limb ischemia in a 4-week-old newborn 4周龄新生儿严重急性肢体缺血的手术肢体保存

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-08 DOI: 10.1016/j.avsurg.2025.100362

Manuela Schulz , Johannes Hatzl , Katrin Meisenbacher , Christian Gille , Andreas S. Peters , Dittmar Böckler

This case report describes a successful revascularisation of severe acute limb ischemia (ALI) in a 4-week-old newborn following common femoral artery dissection due to catheterization for invasive blood pressure measurement during cardiac arrest in the intensive care unit. Iatrogenic acute limb ischemia in childhood is very rare and, in selected cases, a fatal condition potentially associated with limb loss and lifelong mobility impairments. The most common cause of acute limb ischemia in newborns is catheter-associated thrombosis. Current clinical guidelines recommend primary conservative management with heparin administration (level of recommendation: Class 1C) for children under 2 years of age. If revascularization is needed and indicated, open surgical techniques are typically performed. The following case report describes successful surgical treatment of acute limb ischemia in the context of current literature on ALI in childhood, including clinical presentation, diagnosis, treatment, and follow-up.

本病例报告描述了一个4周大的新生儿，在重症监护室心脏骤停期间，由于导管插入有创血压测量导致普通股动脉夹层，导致严重急性肢体缺血（ALI）的血运重建成功。儿童期医源性急性肢体缺血非常罕见，在某些情况下，这是一种致命的疾病，可能与肢体丧失和终身行动障碍有关。新生儿急性肢体缺血最常见的原因是导管相关血栓形成。目前的临床指南推荐对2岁以下儿童进行肝素治疗（推荐级别：1C级）。如果需要和指征，通常采用开放手术技术。以下病例报告描述了在目前关于儿童ALI的文献背景下，成功的手术治疗急性肢体缺血，包括临床表现、诊断、治疗和随访。

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引用次数: 0

Takayasu arteritis beyond the young: What to consider? 高须动脉炎超越年轻人：该考虑什么？

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-07 DOI: 10.1016/j.avsurg.2025.100361

Suci Indriani , Averina Geffanie Suwana , Suko Adiarto , Taofan , Ruth Grace Aurora , Iwan Dakota

Background

Takayasu arteritis (TA), also known as the pulseless disease, is a rare systemic inflammatory condition that damages medium and larger arteries. With an incidence rate of 2–6 per million, it predominantly affects individuals aged 20–40. Clinical manifestations vary from asymptomatic cases to severe vascular damage, often complicating diagnosis. This report aims to shed light on diagnosing Takayasu arteritis in older women.

Case Summary

A 57-year-old Southeast Asian woman presented with intermittent claudication of the upper and lower limbs. Examination revealed a significant systolic blood pressure discrepancy of 60 mmHg between the left and right leg, and vascular bruits over the subclavian arteries. Laboratory tests showed high inflammatory markers and positive ANA. Imaging with duplex ultrasound and CT scan revealed total occlusion of bilateral superficial femoral artery and stenosis of the subclavian arteries. Based on the findings, the patient was diagnosed with Takayasu arteritis. Treatment with high-dose corticosteroids and methotrexate (Methotrexate), along with antihypertensive and antiplatelet drugs, led to symptom improvement and no adverse events at the 1-year follow-up.

Discussion

Takayasu arteritis, while primarily affecting the young, can manifest in older individuals, presenting diagnostic challenges due to its rarity and non-specific symptoms. This case underscores the importance of including TA in the differential diagnosis for older patients with vascular symptoms. Individualized and tailored management of immunosuppressive therapy and regular monitoring are essential to control disease progression and improve outcomes.

takayasu动脉炎（takayasu arteritis， TA），也被称为无脉性疾病，是一种罕见的系统性炎症，损害中大动脉。发病率为百万分之2-6，主要影响20-40岁的人群。临床表现从无症状到严重血管损伤不等，常使诊断复杂化。本报告旨在阐明老年妇女高须动脉炎的诊断。病例摘要：一名57岁东南亚女性，表现为间歇性上肢和下肢跛行。检查发现左腿和右腿之间明显的收缩压差为60毫米汞柱，锁骨下动脉上有血管瘀伤。实验室检查显示高炎症标志物和ANA阳性。双工超声及CT显示双侧股浅动脉完全闭塞，锁骨下动脉狭窄。根据检查结果，该患者被诊断为Takayasu动脉炎。大剂量皮质类固醇和甲氨蝶呤（甲氨蝶呤）治疗，以及抗高血压和抗血小板药物，导致症状改善，1年随访无不良事件。高须动脉炎虽然主要影响年轻人，但也可在老年人中表现出来，由于其罕见和非特异性症状，给诊断带来了挑战。本病例强调了将TA纳入有血管症状的老年患者鉴别诊断的重要性。个性化和量身定制的免疫抑制治疗管理和定期监测对于控制疾病进展和改善结果至关重要。

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引用次数: 0

Thoracic aorta to inferior mesenteric artery bypass for treatment of chronic mesenteric ischemia 胸主动脉至肠系膜下动脉搭桥治疗慢性肠系膜缺血

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-03 DOI: 10.1016/j.avsurg.2025.100360

Marjorie R. Liggett , Margaret A. Reilly , Nidhi Reddy , Nicholas S. Lysak , Heron Rodriguez , Neel A. Mansukhani

Despite the prevalence of mesenteric artery occlusive disease in the elderly population, revascularization for chronic mesenteric ischemia (CMI) accounts for <2 % of revascularization procedures. We describe a case of a 72-year-old male with CMI who previously underwent SMA angioplasty and stenting, and supraceliac aorta to superior mesenteric artery (SMA) bypass that subsequently thrombosed. We performed a right common iliac to SMA bypass with initial improvement in his symptoms. However, at one month follow-up, he had symptom recurrence with imaging revealing occlusion of his bypass. We subsequently performed a distal thoracic aorta to inferior mesenteric artery (IMA) bypass via a thoracoabdominal retroperitoneal approach, resulting in resolution of his symptoms.

尽管老年人群中存在肠系膜动脉闭塞疾病，但慢性肠系膜缺血（CMI）的血运重建术占血运重建术的2%。我们描述了一例72岁的CMI男性患者，他之前接受了SMA血管成形术和支架植入术，并将腹腔上主动脉与肠系膜上动脉（SMA）搭桥，随后血栓形成。我们对他进行了右髂总动脉到SMA的搭桥手术，初步改善了他的症状。然而，在一个月的随访中，他的症状复发，影像学显示他的旁路闭塞。随后，我们通过胸腹腹膜后入路行胸主动脉远端至肠系膜下动脉（IMA）旁路手术，使他的症状得到缓解。

引用次数: 0

Cross-pelvic retrograde embolization of an enlarging proximally occluded internal iliac artery aneurysm: A case report 经盆腔逆行栓塞治疗增大的近端闭塞髂内动脉瘤1例

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-01 DOI: 10.1016/j.avsurg.2024.100359

Alyssa J. Pyun, Ashley C. Hsu , Sukgu M. Han, Fred A. Weaver, Gregory A. Magee

Internal iliac artery aneurysms are frequently treated by embolization and stent graft coverage, however, retrograde flow from pelvic collaterals may lead to aneurysm progression that can be difficult to treat. We present the case of a 76-year-old male with an enlarging internal iliac artery aneurysm despite occlusion of the proximal internal iliac artery and no antegrade filling of the aneurysm sac. Through cross-pelvic retrograde access of the aneurysm sac via collaterals, we used a triaxial telescoping system for embolization of the aneurysm nidus, without major morbidity. This technique is a safe and effective option that can be used in cases where antegrade access is not feasible.

髂内动脉瘤通常通过栓塞和支架覆盖来治疗，然而，骨盆侧支的逆行血流可能导致动脉瘤进展，难以治疗。我们报告一名76岁男性病患，尽管髂内近端动脉闭塞，但动脉瘤囊未顺行填充，但髂内动脉动脉瘤仍扩大。通过经侧支的跨盆腔逆行进入动脉瘤囊，我们使用三轴伸缩系统栓塞动脉瘤病灶，无重大并发症。这种技术是一种安全有效的选择，可以在不能顺行进入的情况下使用。

引用次数: 0

Ultrasound-guided percutaneous aspiration as an alternative method of treatment for Adventitial Cystic Disease: A case series 超声引导下经皮穿刺作为治疗外膜囊性疾病的一种替代方法：一个病例系列

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2024-12-28 DOI: 10.1016/j.avsurg.2024.100358

Nikolaos Patelis , Ioannis Tsagkos , Alia Madi , Vasiliki Bakalaki , Maria Psarrou , Bahaa Arefai

Introduction

Adventitial cystic disease (ACyD) is a rare vascular condition, first documented in 1947, representing approximately 0.1 % of vascular disorders, most commonly affecting the popliteal artery. The condition presents primarily with symptoms of intermittent claudication. Traditional treatment options include cyst excision, arterial segment removal with vein graft reconstruction, or percutaneous aspiration.

Materials and Methods

This publication reports on the results of three patients diagnosed with ACyD (males 66 %, mean age 46 years old) and treated with ultrasound-guided percutaneous aspiration (UGPA) as the initial approach. The patients were recruited over a five-year period in two private hospitals and their main symptom was claudication (Rutherford 2 and 3). The main symptom was intermittent claudication.

Results

All three patients were succesfully treated with UGPA (100 % technical success) and reported immediate increase of their walking distance and total resolution of claudication. All patients remain symptom-free at 15.7 months (range 7-30). No additional procedures were necessary.

Conclusion

Ultrasound-guided percutaneous aspiration for ACyD appears to be a safe and effective initial treatment that restores blood flow in affected vessels. Further long-term follow-up is necessary to establish the durability of the treatment outcomes.

外膜囊性疾病（ACyD）是一种罕见的血管疾病，1947年首次有文献记载，约占血管疾病的0.1%，最常影响腘动脉。此病主要表现为间歇性跛行。传统的治疗方案包括囊肿切除，动脉段切除和静脉移植重建，或经皮穿刺。材料与方法本文报道3例ACyD患者（男性66%，平均年龄46岁），采用超声引导下经皮穿刺（UGPA）作为初始入路治疗。患者在两家私立医院招募，为期五年，主要症状为跛行（Rutherford 2和3）。主要症状为间歇性跛行。结果3例患者均获得UGPA治疗（100%技术成功率），步行距离明显增加，跛行症状完全缓解。所有患者在15.7个月（范围7-30）时仍无症状。不需要额外的程序。结论超声引导下经皮穿刺治疗ACyD是一种安全有效的治疗方法，可恢复病变血管血流。需要进一步的长期随访来确定治疗结果的持久性。

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引用次数: 0

Outcome of retrograde approach in management of chronic arterial occlusive disease of lower extremities 逆行入路治疗下肢慢性动脉闭塞性疾病的疗效

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2024-12-25 DOI: 10.1016/j.avsurg.2024.100357

Tran Minh Bao Luan , Luong Viet Thang , Viet Huan Le

Introduction

Peripheral arterial disease or chronic arterial occlusive disease of lower extremities is a common problem, and in the advanced stages of the disease, if not re-vascularized, the rate of amputation and mortality can be as high as 43 % and 25 % respectively. Many studies also show that the rate of successful revascularization with an antegrade approach has a failure rate of 10–20 %. Therefore, the retrograde intervention technique was developed to increase the success rate of revascularization.

Objectives

Morphological classification of lesions and results of retrograde approach in the treatment of chronic arterial occlusive disease in lower extremities.

Method

Retrospective descriptive study. Thirty-five patients with 39 limbs received intervention with the retrograde approach at the Department of Thoracic and Vascular Surgery, University Medical Center. Ho Chi Minh City from February 2017 to December 2021.

Results

Most of the patients had multiple risk factors, including hypertension, diabetes, high grade on the Rutherford scale (79.5 % with Rutherford 5), and diffuse vascular disease (89.8 % GLASS III). Recanalization was technically successful in 84.6 % (33/39) limbs, and the patients with limb preservation rate at 6 months after intervention 88.5 %. Results at 12 and 24 months also confirm the procedure's feasibility and positive outlook. The local complication rate was low 7.7 % (3/39). There was 1 case that died 3 weeks after the intervention, not directly related to the procedure.

Conclusion

The retrograde technique is safe and effective in managing chronic total arterial occlusive disease of the lower limbs.

下肢外周动脉疾病或慢性动脉闭塞性疾病是一个常见的问题，在疾病的晚期，如果不进行血管重建，截肢率和死亡率分别可高达43%和25%。许多研究还表明，顺行入路血运重建成功率为10 - 20%。因此，为了提高血运重建的成功率，逆行介入技术应运而生。目的探讨逆行入路治疗下肢慢性动脉闭塞性疾病的病理形态分型及效果。方法回顾性描述性研究。大学医学中心胸血管外科35例患者39条肢体行逆行入路介入治疗。胡志明市2017年2月至2021年12月。结果大多数患者存在多重危险因素，包括高血压、糖尿病、Rutherford分级高（Rutherford 5）（79.5%）和弥漫性血管疾病（GLASS III）（89.8%）， 84.6%（33/39）肢体技术上成功再通，干预后6个月肢体保存率88.5%。12个月和24个月的结果也证实了手术的可行性和积极的前景。局部并发症发生率低7.7%（3/39）。干预后3周死亡1例，与手术无直接关系。结论逆行手术治疗下肢慢性全动脉闭塞症安全有效。

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引用次数: 0

The experience of a vascular service in the Anglo-Caribbean with COVID-19 associated arterial thrombosis- A case series 盎格鲁-加勒比地区与COVID-19相关动脉血栓形成的血管服务经验-病例系列

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2024-12-10 DOI: 10.1016/j.avsurg.2024.100356

Dave Harnanan , Kelly Ann Bobb , Lemuel Pran , Aruna Rampersad , Vijay Naraynsingh , Terrence Seemungal

Introduction

This study aimed to examine the characteristics and clinical outcomes of coronavirus (COVID-19) positive patients presenting with acute limb ischemia (ALI) during the coronavirus pandemic.

Design and methods

A multi-center, observational study was undertaken. It included patients from three tertiary parallel healthcare facilities in Trinidad and Tobago who were COVID-19 positive and had an acute thromboembolic event between August 2020 and April 2022. The data was collected in a prospectively maintained database.

Results

Over the 21 months, 24 patients with ALI and were infected with COVID-19 were evaluated, analyzing 25 consecutive limbs. The cohort's median age was 62.2 years (42–88 years), of which 62.5% were male. The most common comorbidities were diabetes (45.8%) and hypertension (33.3%). 12.5% (3/24) of patients’ initial manifestation was acute arterial ischemia, with the remaining patients (87.5%) developing signs of ALI during their hospitalization for their COVID-19 infection. Additionally, 12.5% (3/24) of patients were found to have had extremity thrombosis at multiple levels. Treatment arms were categorized as medical (N= 16), surgical (open surgery 7, and endovascular 2) management. There were no major adverse limb events in patients treated surgically. Non-surgical management was more prevalent in severe cases of Covid-19 disease in 37.5%. The in-hospital mortality was 41.7% (the leading cause of death being acute respiratory distress syndrome and multiorgan failure), all of whom were managed medically.

Conclusion

COVID-19 posed unique challenges in the management of ALI, with increased mortality and primary amputation rates. However, in patients who underwent surgical revascularization, there was a 100% major amputation-free survival at 24 months.

本研究旨在探讨冠状病毒（COVID-19）阳性患者在冠状病毒大流行期间出现急性肢体缺血（ALI）的特点和临床结局。设计与方法采用多中心观察性研究。该研究包括来自特立尼达和多巴哥三个三级平行医疗机构的患者，他们在2020年8月至2022年4月期间呈COVID-19阳性并发生急性血栓栓塞事件。数据收集在前瞻性维护的数据库中。结果在21个月的时间里，对24例ALI合并COVID-19感染的患者进行了评估，分析了25个连续肢体。该队列的中位年龄为62.2岁（42-88岁），其中62.5%为男性。最常见的合并症是糖尿病（45.8%）和高血压（33.3%）。12.5%（3/24）的患者最初表现为急性动脉缺血，其余患者（87.5%）因感染COVID-19住院期间出现ALI体征。12.5%（3/24）的患者存在多级别肢体血栓。治疗组分为内科治疗组（N= 16）、外科治疗组（开放手术组7）和血管内治疗组2。手术治疗的患者无重大肢体不良事件。非手术治疗在重症病例中更为普遍，占37.5%。住院死亡率为41.7%（主要死亡原因为急性呼吸窘迫综合征和多器官衰竭），所有患者均接受医学治疗。结论2019冠状病毒病对急性呼吸道感染的管理提出了独特的挑战，死亡率和原发性截肢率增加。然而，在接受手术血运重建术的患者中，24个月的无截肢生存率为100%。

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引用次数: 0

Deep venous arterialization in the acute setting for embolic complication after endovascular procedure 血管内手术后栓塞并发症的急性深静脉动脉化

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2024-12-08 DOI: 10.1016/j.avsurg.2024.100355

Alejandra P. Rodriguez , Antonio Solano , Sofia K. Babool , Suyue M. Zhang , Lawrence A. Lavery , Michael C. Siah

We report a case of a patient that developed acute limb ischemia secondary to atherectomy related embolization that was rescued with a deep venous arterialization (DVA) procedure. For patients with critical limb-threatening ischemia, deep vein arterialization is a viable and crucial intervention for non-surgical candidates who present with wounds or rest pain. This case report underscores DVA's efficacy in addressing severe presentations even in the case of acute ischemia.

我们报告一例患者发生急性肢体缺血继发于动脉粥样硬化切除术相关的栓塞，并通过深静脉动脉化（DVA）手术获救。对于严重肢体缺血的患者，深静脉动脉化是一种可行的和关键的干预措施，非手术候选人出现伤口或休息疼痛。本病例报告强调了DVA在解决严重表现的有效性，即使是在急性缺血的情况下。

引用次数: 0

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