Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100188
Jan C. van de Voort MD , Lise I.P. Duijvestijn BSc , Boudewijn L.S. Borger van der Burg MD, PhD , Rigo Hoencamp MD, PhD
<div><h3>Objective</h3><div>Resuscitative endovascular balloon occlusion of the aorta (REBOA) use closer to the point-of-trauma could reduce prehospital mortality by temporary controlling non-compressible truncal hemorrhage (NCTH). Reliable external anatomic landmarks or body surface reference points, such as mid-sternum for zone I, are not available for zone III balloon placement. In the absence of radiographic or ultrasound balloon position confirmation, unintentional zone II placement can therefore occur. Although evidence is limited, the concerns regarding possible zone II occlusion could hamper implementation of REBOA in prehospital settings as imaging guidance is not always available. The aim of this study was to provide an extensive overview of aortic anatomy with zone II morphology and aortic branch diameters in European patients without vascular disease history. Concurrently, multiple previously proposed REBOA insertion lengths were validated with comparison of accidental out of zone III error rates, extensiveness of unintentional zone II placements, and occlusion of the aortic branches.</div></div><div><h3>Methods</h3><div>Contrast enhanced computed tomography scans from 242 Dutch non-trauma patients (146 females; mean age, 46 years) were analyzed. Central luminal line distances, including skin depths, were measured from the bilateral common femoral artery access points (FAAPs) to the middle and boundaries of the aortic occlusion zones and proximal and distal origins of the visceral branches. Mean intravascular distances from the FAAPs to the levels of interest and branch diameters were determined for all combined sex and age-based subgroups. Subsequently, a 40-mm long balloon introduction simulation was performed to precisely determine the extensiveness and degree of zone II branch occlusion of earlier proposed REBOA insertion lengths.</div></div><div><h3>Results</h3><div>The mean distance from the left and right FAAPs to mid-zone III ranged between 233 and 251 mm and 238 and 257 mm, respectively. Mean zone III length was 87 mm (females, 85.4 mm; males, 88.7 mm) with a maximum difference of 4 mm (4.7%) between the four subgroups. The right iliofemoral trajectory was 5 mm longer regardless of sex or age. Mean zone II length was 45 mm (females, 43.8 mm; males, 47.3 mm), with a maximum 6 mm difference (14.3%). The mean superior mesenteric artery and celiac trunk diameters were 11.4 and 11.2 mm in females and 12.7 and 11.9 mm in males, respectively. Up to the celiac trunk, 66% of the mean age-based elongation originated in the iliofemoral trajectory (6 of total 9 mm), regardless of insertion side. No statistically significant age-based differences were seen for the zone lengths or branch diameters. Unintentional zone II placement error rates up to 71% were observed for previously proposed fixed-distance insertion lengths, but the extensiveness of aortic branch occlusion varied. Partial iliac artery placement error rates varied between 0 an
{"title":"Exploration of abdominal aorta morphology for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement evaluation with an analysis of zone II anatomy and aortic branch diameters","authors":"Jan C. van de Voort MD , Lise I.P. Duijvestijn BSc , Boudewijn L.S. Borger van der Burg MD, PhD , Rigo Hoencamp MD, PhD","doi":"10.1016/j.jvsvi.2025.100188","DOIUrl":"10.1016/j.jvsvi.2025.100188","url":null,"abstract":"<div><h3>Objective</h3><div>Resuscitative endovascular balloon occlusion of the aorta (REBOA) use closer to the point-of-trauma could reduce prehospital mortality by temporary controlling non-compressible truncal hemorrhage (NCTH). Reliable external anatomic landmarks or body surface reference points, such as mid-sternum for zone I, are not available for zone III balloon placement. In the absence of radiographic or ultrasound balloon position confirmation, unintentional zone II placement can therefore occur. Although evidence is limited, the concerns regarding possible zone II occlusion could hamper implementation of REBOA in prehospital settings as imaging guidance is not always available. The aim of this study was to provide an extensive overview of aortic anatomy with zone II morphology and aortic branch diameters in European patients without vascular disease history. Concurrently, multiple previously proposed REBOA insertion lengths were validated with comparison of accidental out of zone III error rates, extensiveness of unintentional zone II placements, and occlusion of the aortic branches.</div></div><div><h3>Methods</h3><div>Contrast enhanced computed tomography scans from 242 Dutch non-trauma patients (146 females; mean age, 46 years) were analyzed. Central luminal line distances, including skin depths, were measured from the bilateral common femoral artery access points (FAAPs) to the middle and boundaries of the aortic occlusion zones and proximal and distal origins of the visceral branches. Mean intravascular distances from the FAAPs to the levels of interest and branch diameters were determined for all combined sex and age-based subgroups. Subsequently, a 40-mm long balloon introduction simulation was performed to precisely determine the extensiveness and degree of zone II branch occlusion of earlier proposed REBOA insertion lengths.</div></div><div><h3>Results</h3><div>The mean distance from the left and right FAAPs to mid-zone III ranged between 233 and 251 mm and 238 and 257 mm, respectively. Mean zone III length was 87 mm (females, 85.4 mm; males, 88.7 mm) with a maximum difference of 4 mm (4.7%) between the four subgroups. The right iliofemoral trajectory was 5 mm longer regardless of sex or age. Mean zone II length was 45 mm (females, 43.8 mm; males, 47.3 mm), with a maximum 6 mm difference (14.3%). The mean superior mesenteric artery and celiac trunk diameters were 11.4 and 11.2 mm in females and 12.7 and 11.9 mm in males, respectively. Up to the celiac trunk, 66% of the mean age-based elongation originated in the iliofemoral trajectory (6 of total 9 mm), regardless of insertion side. No statistically significant age-based differences were seen for the zone lengths or branch diameters. Unintentional zone II placement error rates up to 71% were observed for previously proposed fixed-distance insertion lengths, but the extensiveness of aortic branch occlusion varied. Partial iliac artery placement error rates varied between 0 an","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100220
Nadia O. Trabelsi MD , Laura M. Drudi MD, CM, MSc, FRCSC , Jean-François Blair MD, FRCSC , Stephane Elkouri MD, FRCSC , Nathalie Beaudoin MD, FRCSC , Pierre Perreault MD, FSIR , Gilles Soulez MD, MSc, FSIR , Philippe Charbonneau MD, CM, FRCSC
Objective
This study sought to review clinical outcomes in patients who underwent endovascular treatment for chronic mesenteric ischemia (CMI).
Methods
A retrospective study was performed from June 1, 2019, to October 31, 2023, including consecutive CMI patients undergoing endovascular revascularization at a single institution. The primary end point was the 30-day mortality rate. The secondary end points were the 12-month mortality, primary patency, primary-assisted patency, and secondary patency rate . Descriptive statistics were gathered for primary and secondary outcomes. Univariate and multivariable logistic regressions were performed to identify covariates associated with the primary end point.
Results
Our cohort consisted of 37 patients with a mean age of 73 ± 10 years, and most were female patients (76%). There were 15 patients (41%) who had a diagnosis of acute-on-CMI. Most procedures were done semiemergently (62%) and were performed by a vascular surgeon (95%). At 30 days, there were three deaths (8%) and four additional deaths at 12 months. For our primary end point, there was a trend that advanced age (odds ratio, 1.01; 95% confidence interval, 0.93-1.09) and male sex (odds ratio, 1.31; 95% confidence interval, 0.21-8.32) were associated with 30-day mortality on univariate analysis. On multivariable logistic regression, age and sex were not associated with 30-day mortality. Our clinical outcomes show a primary patency rate of 86%, a primary-assisted patency rate of 89%, and a secondary patency rate of 92% at 12 months.
Conclusions
Our study demonstrated acceptable primary stent patency in a heterogeneous population. There were trends linking advanced age and male sex to poorer outcomes. Future research should explore predictors of lower stent patency, such as small stent size and diameter, and investigate sex-based differences in larger cohorts.
{"title":"Moderate risk of all-cause mortality and stent-related complications in patients undergoing endovascular treatment for chronic mesenteric ischemia","authors":"Nadia O. Trabelsi MD , Laura M. Drudi MD, CM, MSc, FRCSC , Jean-François Blair MD, FRCSC , Stephane Elkouri MD, FRCSC , Nathalie Beaudoin MD, FRCSC , Pierre Perreault MD, FSIR , Gilles Soulez MD, MSc, FSIR , Philippe Charbonneau MD, CM, FRCSC","doi":"10.1016/j.jvsvi.2025.100220","DOIUrl":"10.1016/j.jvsvi.2025.100220","url":null,"abstract":"<div><h3>Objective</h3><div>This study sought to review clinical outcomes in patients who underwent endovascular treatment for chronic mesenteric ischemia (CMI).</div></div><div><h3>Methods</h3><div>A retrospective study was performed from June 1, 2019, to October 31, 2023, including consecutive CMI patients undergoing endovascular revascularization at a single institution. The primary end point was the 30-day mortality rate. The secondary end points were the 12-month mortality, primary patency, primary-assisted patency, and secondary patency rate . Descriptive statistics were gathered for primary and secondary outcomes. Univariate and multivariable logistic regressions were performed to identify covariates associated with the primary end point.</div></div><div><h3>Results</h3><div>Our cohort consisted of 37 patients with a mean age of 73 ± 10 years, and most were female patients (76%). There were 15 patients (41%) who had a diagnosis of acute-on-CMI. Most procedures were done semiemergently (62%) and were performed by a vascular surgeon (95%). At 30 days, there were three deaths (8%) and four additional deaths at 12 months. For our primary end point, there was a trend that advanced age (odds ratio, 1.01; 95% confidence interval, 0.93-1.09) and male sex (odds ratio, 1.31; 95% confidence interval, 0.21-8.32) were associated with 30-day mortality on univariate analysis. On multivariable logistic regression, age and sex were not associated with 30-day mortality. Our clinical outcomes show a primary patency rate of 86%, a primary-assisted patency rate of 89%, and a secondary patency rate of 92% at 12 months.</div></div><div><h3>Conclusions</h3><div>Our study demonstrated acceptable primary stent patency in a heterogeneous population. There were trends linking advanced age and male sex to poorer outcomes. Future research should explore predictors of lower stent patency, such as small stent size and diameter, and investigate sex-based differences in larger cohorts.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100218
Mackenzie d’Entremont-Harris BSc, BSc (Pharm), ACPR , Thomas Parker BSc (Pharm), ACPR , Susan Bowles BSc (Pharm), MSc, PharmD, FCSHP , Min Lee MD, FRCSC , Samuel Jessula MD, MSc, FRCSC , Michael MacNeil PharmD, ACPR
Background
Patients with peripheral arterial disease (PAD) are at an increased risk of coronary artery disease and related complications. PAD and coronary artery disease share modifiable risk factors, and pharmacological treatment reduces cardiovascular (CV) events and mortality. Characterizing prescribing trends of evidence-based CV risk-modifying medications and recognizing care gaps are important steps in improving patient outcomes. The study objective was to determine the proportion of patients with PAD-related chronic limb-threatening ischemia prescribed CV risk-modifying medications (angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker [ACEi/ARB], statin, and antiplatelet) on discharge from vascular surgery care.
Methods
This single-center, retrospective cohort study included patients with chronic limb-threatening ischemia admitted to the vascular surgery service at a tertiary care center. Inferential statistics were used to describe patients not prescribed CV risk-modifying medications. Multivariable logistic regression was used to determine any independent association of medication, disease, and demographic factors with a prescription for CV risk-modifying medications.
Results
: A total of 178 patients met the inclusion criteria, of whom 56 (32%) were prescribed an ACEi/ARB, statin, and antiplatelet medication on admission and 76 (43%) at discharge. Coronary artery disease (adjusted odds ratio [aOR]: 2.23, 95% confidence interval [CI]: 1.09-4.55) and dyslipidemia (aOR: 3.84, 95% CI: 1.87-7.88) were associated with increased odds of being prescribed CV risk-modifying medications; atrial fibrillation was associated with decreased odds (aOR: 0.19, 95% CI: 0.06-0.61).
Conclusions
Only 43% of the study population was prescribed an ACEi/ARB, statin, and antiplatelet medication at discharge, demonstrating a gap in care. The low prescribing rate of CV risk-modifying medications in this population warrants further investigation and highlights a key area to focus medical risk modification efforts.
{"title":"Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia","authors":"Mackenzie d’Entremont-Harris BSc, BSc (Pharm), ACPR , Thomas Parker BSc (Pharm), ACPR , Susan Bowles BSc (Pharm), MSc, PharmD, FCSHP , Min Lee MD, FRCSC , Samuel Jessula MD, MSc, FRCSC , Michael MacNeil PharmD, ACPR","doi":"10.1016/j.jvsvi.2025.100218","DOIUrl":"10.1016/j.jvsvi.2025.100218","url":null,"abstract":"<div><h3>Background</h3><div>Patients with peripheral arterial disease (PAD) are at an increased risk of coronary artery disease and related complications. PAD and coronary artery disease share modifiable risk factors, and pharmacological treatment reduces cardiovascular (CV) events and mortality. Characterizing prescribing trends of evidence-based CV risk-modifying medications and recognizing care gaps are important steps in improving patient outcomes. The study objective was to determine the proportion of patients with PAD-related chronic limb-threatening ischemia prescribed CV risk-modifying medications (angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker [ACEi/ARB], statin, and antiplatelet) on discharge from vascular surgery care.</div></div><div><h3>Methods</h3><div>This single-center, retrospective cohort study included patients with chronic limb-threatening ischemia admitted to the vascular surgery service at a tertiary care center. Inferential statistics were used to describe patients not prescribed CV risk-modifying medications. Multivariable logistic regression was used to determine any independent association of medication, disease, and demographic factors with a prescription for CV risk-modifying medications.</div></div><div><h3>Results</h3><div>: A total of 178 patients met the inclusion criteria, of whom 56 (32%) were prescribed an ACEi/ARB, statin, and antiplatelet medication on admission and 76 (43%) at discharge. Coronary artery disease (adjusted odds ratio [aOR]: 2.23, 95% confidence interval [CI]: 1.09-4.55) and dyslipidemia (aOR: 3.84, 95% CI: 1.87-7.88) were associated with increased odds of being prescribed CV risk-modifying medications; atrial fibrillation was associated with decreased odds (aOR: 0.19, 95% CI: 0.06-0.61).</div></div><div><h3>Conclusions</h3><div>Only 43% of the study population was prescribed an ACEi/ARB, statin, and antiplatelet medication at discharge, demonstrating a gap in care. The low prescribing rate of CV risk-modifying medications in this population warrants further investigation and highlights a key area to focus medical risk modification efforts.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Artificial intelligence (AI) is rapidly transforming vascular care by enhancing diagnostic accuracy, streamlining pre-interventional planning, and improving patient outcomes. Given the inherent complexity of vascular conditions and the emergence of big data, AI has emerged as a promising tool to address longstanding challenges in clinical decision-making, surgical precision, and health care efficiency.
Methods
This review synthesizes recent literature on the integration of AI into vascular care, focusing on its clinical applications, financial implications, and ethical considerations. Specific attention is given to the use of machine learning and deep learning in imaging analysis, AI-driven predictive analytics for patient stratification and risk modeling, and the evolution of robotic-assisted surgical techniques. The review also explores cost-effectiveness data, resource optimization, and challenges such as algorithmic bias and data privacy.
Results
AI applications in vascular care have demonstrated high accuracy in image interpretation, enhanced risk prediction for postoperative outcomes, and greater precision in robotic-assisted interventions. Machine learning models have improved workflow efficiency, reduced diagnostic errors, and enabled early identification of vascular pathology. Financial models suggest that AI implementation can reduce hospital readmissions, operating time, and resource waste, whereas wearable technology and digital twin models show promise for personalized, real-time patient monitoring. Despite these advances, concerns remain about equitable access, transparency, and clinical integration.
Conclusions
AI holds significant promise in revolutionizing vascular care by enabling personalized treatment plans, improving procedural outcomes, and optimizing system-level efficiency. However, broader adoption will require ongoing interdisciplinary collaboration, robust data governance, and ethical oversight to ensure that AI-driven solutions are both effective and equitable in clinical practice.
{"title":"The role of artificial intelligence in vascular care","authors":"Nehaar Nimmagadda BS , Edouard Aboian MD , Sharon Kiang MD , Uwe Fischer MD","doi":"10.1016/j.jvsvi.2024.100179","DOIUrl":"10.1016/j.jvsvi.2024.100179","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is rapidly transforming vascular care by enhancing diagnostic accuracy, streamlining pre-interventional planning, and improving patient outcomes. Given the inherent complexity of vascular conditions and the emergence of big data, AI has emerged as a promising tool to address longstanding challenges in clinical decision-making, surgical precision, and health care efficiency.</div></div><div><h3>Methods</h3><div>This review synthesizes recent literature on the integration of AI into vascular care, focusing on its clinical applications, financial implications, and ethical considerations. Specific attention is given to the use of machine learning and deep learning in imaging analysis, AI-driven predictive analytics for patient stratification and risk modeling, and the evolution of robotic-assisted surgical techniques. The review also explores cost-effectiveness data, resource optimization, and challenges such as algorithmic bias and data privacy.</div></div><div><h3>Results</h3><div>AI applications in vascular care have demonstrated high accuracy in image interpretation, enhanced risk prediction for postoperative outcomes, and greater precision in robotic-assisted interventions. Machine learning models have improved workflow efficiency, reduced diagnostic errors, and enabled early identification of vascular pathology. Financial models suggest that AI implementation can reduce hospital readmissions, operating time, and resource waste, whereas wearable technology and digital twin models show promise for personalized, real-time patient monitoring. Despite these advances, concerns remain about equitable access, transparency, and clinical integration.</div></div><div><h3>Conclusions</h3><div>AI holds significant promise in revolutionizing vascular care by enabling personalized treatment plans, improving procedural outcomes, and optimizing system-level efficiency. However, broader adoption will require ongoing interdisciplinary collaboration, robust data governance, and ethical oversight to ensure that AI-driven solutions are both effective and equitable in clinical practice.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100179"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100239
Jianbin Zhang MD, Qiangqiang Nie MD, Bin He MD, Bo Ma MD, Xueqiang Fan MD, Peng Liu MD, Zhidong Ye MD
Objective
We evaluated the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension complications.
Methods
We retrospectively analyzed the demographics, treatment details, and outcomes data of 89 patients with portal hypertension complications treated with TIPS from March 2020 to June 2023. The etiology of portal hypertension included viral hepatitis, alcoholic liver disease, autoimmune liver disease, sinusoidal obstruction syndrome, and Budd-Chiari syndrome.
Results
The final study population consisted of 89 patients, including 43 patients with viral hepatitis, 21 with alcoholic liver disease, 18 with autoimmune liver disease, 4 with sinusoidal obstruction syndrome, and 3 with Budd-Chiari syndrome. Five emergent and 84 elective TIPS procedures were carried out, and the TIPS technical procedure successful rate was 100%. The stent configuration included 5 cases with a bare metal stent, 42 cases with a multilayer bare metal stent, 32 cases with a bare and covered stent combination, and 10 cases with a stent designed for TIPS. The preprocedural and postprocedural mean portocaval pressure gradient was 27.66 ± 5.69 and 13.73 ± 3.63 cm H2O (P < .05), respectively. The 1-year recurrent variceal bleeding or refractory ascites rate was 12.36% and the 1-year TIPS shunt dysfunction rate was 13.48%. The incidence of overt encephalopathy and minimal encephalopathy was 8.99% and 21.35%, respectively. One patient suffered from hepatic coma and treated with TIPS shunt embolization. During the 1-year follow-up, seven patients were diagnosed with hepatocellular carcinoma, three patients underwent liver transplantation, and six patients died.
Conclusions
TIPS is a safe and effective treatment modality for portal hypertension complications. The incidence of hepatic encephalopathy is acceptable by proper patient selection and pharmacological treatment. More attention should be paid to this technique in China to benefit the large amounts of patients with complications of portal hypertension.
目的评价经颈静脉肝内门静脉系统分流术（TIPS）治疗门静脉高压症并发症的疗效和安全性。方法回顾性分析2020年3月至2023年6月接受TIPS治疗的89例门静脉高压并发症患者的人口统计学、治疗细节和结局资料。门静脉高压症的病因包括病毒性肝炎、酒精性肝病、自身免疫性肝病、窦阻塞综合征和Budd-Chiari综合征。结果最终研究人群包括89例患者，其中病毒性肝炎43例，酒精性肝病21例，自身免疫性肝病18例，窦道阻塞综合征4例，Budd-Chiari综合征3例。实施紧急TIPS手术5例，选择性TIPS手术84例，TIPS技术手术成功率100%。支架配置包括5例裸金属支架，42例多层裸金属支架，32例裸覆盖支架组合，10例TIPS支架。术前和术后门静脉平均压力梯度分别为27.66±5.69和13.73±3.63 cm H2O (P <；. 05),分别。1年复发静脉曲张出血或难治性腹水率为12.36%，1年TIPS分流功能障碍率为13.48%。显性脑病和轻度脑病的发生率分别为8.99%和21.35%。1例肝昏迷患者行TIPS分流栓塞治疗。在1年的随访中，7例患者被诊断为肝细胞癌，3例患者接受肝移植，6例患者死亡。结论stips治疗门静脉高压症是一种安全有效的治疗方法。肝性脑病的发生率通过适当的患者选择和药物治疗是可以接受的。为了使大量门静脉高压症并发症患者受益，在中国应给予更多的重视。
{"title":"Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension complications: A single-center retrospective cohort","authors":"Jianbin Zhang MD, Qiangqiang Nie MD, Bin He MD, Bo Ma MD, Xueqiang Fan MD, Peng Liu MD, Zhidong Ye MD","doi":"10.1016/j.jvsvi.2025.100239","DOIUrl":"10.1016/j.jvsvi.2025.100239","url":null,"abstract":"<div><h3>Objective</h3><div>We evaluated the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension complications.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the demographics, treatment details, and outcomes data of 89 patients with portal hypertension complications treated with TIPS from March 2020 to June 2023. The etiology of portal hypertension included viral hepatitis, alcoholic liver disease, autoimmune liver disease, sinusoidal obstruction syndrome, and Budd-Chiari syndrome.</div></div><div><h3>Results</h3><div>The final study population consisted of 89 patients, including 43 patients with viral hepatitis, 21 with alcoholic liver disease, 18 with autoimmune liver disease, 4 with sinusoidal obstruction syndrome, and 3 with Budd-Chiari syndrome. Five emergent and 84 elective TIPS procedures were carried out, and the TIPS technical procedure successful rate was 100%. The stent configuration included 5 cases with a bare metal stent, 42 cases with a multilayer bare metal stent, 32 cases with a bare and covered stent combination, and 10 cases with a stent designed for TIPS. The preprocedural and postprocedural mean portocaval pressure gradient was 27.66 ± 5.69 and 13.73 ± 3.63 cm H<sub>2</sub>O (<em>P</em> < .05), respectively. The 1-year recurrent variceal bleeding or refractory ascites rate was 12.36% and the 1-year TIPS shunt dysfunction rate was 13.48%. The incidence of overt encephalopathy and minimal encephalopathy was 8.99% and 21.35%, respectively. One patient suffered from hepatic coma and treated with TIPS shunt embolization. During the 1-year follow-up, seven patients were diagnosed with hepatocellular carcinoma, three patients underwent liver transplantation, and six patients died.</div></div><div><h3>Conclusions</h3><div>TIPS is a safe and effective treatment modality for portal hypertension complications. The incidence of hepatic encephalopathy is acceptable by proper patient selection and pharmacological treatment. More attention should be paid to this technique in China to benefit the large amounts of patients with complications of portal hypertension.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100239"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100283
Fabrice Stephane Arroye Betou MD , Ferdinand Nyankoue Mebouinz MD , Kobe Fokalbo Zephanie MD , Wilfried Steve Ndeme Mboussi PhD , Charles Mve Mvondo MD , Aristide Bang MD , Papa Adama Dieng MD , Louis Richard Njock MD
<div><h3>Background</h3><div>Data on the prevalence, diagnostic modalities, management sequence, and mortality associated with lower limb fractures/dislocations vary significantly between studies and often do not account for the impact of arterial injury associated with fractures/dislocations on the risks of ischemia, amputation, and severe disability—posing major therapeutic challenges. Considering these uncertain things, we aimed to determine the prevalence, diagnostic modalities, amputation rate, and overall mortality associated with these injuries.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following the Meta-Analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive literature was performed in Medline, Embase, and the World Health Organization Global Health Library, covering the period from January 1, 1960, to April 2024, with no language restrictions. We included observational studies (cohort studies, cross-sectional studies, case-control studies, and retrospective series) reporting on the prevalence, secondary amputation rate, diagnostic and therapeutic modality techniques, histopathological type of vascular injuries, management sequence, and time to hospital admission in cases of combined vascular and musculoskeletal injuries. Two reviewers independently selected studies and extracted data, and methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled estimates for prevalence, amputation, and mortality rates were calculated using meta-analysis. Heterogeneity was assessed using Cochran’s Q χ<sup>2</sup> test and quantified by the I<sup>2</sup> statistic. All analyses were performed using R software version 4.4.2 for Windows.</div></div><div><h3>Results</h3><div>The global prevalence of vascular injuries associated with musculoskeletal trauma was 37% (95% confidence interval [CI], 25%-49%), with substantial heterogeneity across studies (I<sup>2</sup> = 100%; <em>P</em> < .00001). The most frequently reported vascular injury was arterial transection (complete or partial), found in 278 cases (46.3%). Regarding treatment, open surgery was predominant, with vascular bypass in 56.71% of the lower limb trauma population, far ahead of other techniques. Arteriography was historically the most frequently used diagnostic modality, whereas computed tomography angiography has become the most common since the 1990s. The overall amputation rate was 14% (95% CI, 11%-17%; I<sup>2</sup> = 97%; <em>P</em> < .00001), and the overall mortality rate was 9% (95% CI, 6%-12%; I<sup>2</sup> = 86%; <em>P</em> < .00001). Tibial fractures (proximal, midshaft, distal, and multifocal) were significantly associated with injuries to the anterior tibial artery (odds ratio [OR], 9.23; <em>P</em> < .001) and the posterior tibial artery (OR, 7.86; <em>P</em> = .005). Similarly, fibula fractures were associated with posterior tibial artery injury (OR, 7.80; <em>P</em> = .004)
背景：关于下肢骨折/脱位的患病率、诊断方式、治疗顺序和死亡率的数据在不同的研究中差异很大，并且通常没有考虑到与骨折/脱位相关的动脉损伤对缺血、截肢和严重残疾风险的影响，这些风险构成了主要的治疗挑战。考虑到这些不确定因素，我们的目的是确定与这些损伤相关的患病率、诊断方式、截肢率和总死亡率。方法：根据《流行病学观察性研究荟萃分析》（MOOSE）指南进行系统综述和荟萃分析。在Medline、Embase和世界卫生组织全球卫生图书馆中进行了全面的文献研究，涵盖了1960年1月1日至2024年4月期间，没有语言限制。我们纳入了观察性研究（队列研究、横断面研究、病例对照研究和回顾性系列研究），报告了血管和肌肉骨骼联合损伤的患病率、继发截肢率、诊断和治疗方式技术、血管损伤的组织病理学类型、处理顺序和入院时间。两位审稿人独立选择研究和提取数据，并使用纽卡斯尔-渥太华量表评估方法学质量。采用荟萃分析计算患病率、截肢率和死亡率的汇总估计值。异质性采用Cochran’s Q χ2检验，I2统计量量化。所有分析均使用Windows版本的R软件4.4.2进行。结果与肌肉骨骼创伤相关的血管损伤的全球患病率为37%(95%可信区间[CI]， 25%-49%)，各研究存在很大的异质性（I2 = 100%; P < 0.00001）。最常见的血管损伤是动脉横断（完全或部分），278例（46.3%）。在治疗方面，以开放手术为主，血管搭桥手术占下肢创伤患者的56.71%，远远领先于其他技术。动脉造影历来是最常用的诊断方式，而计算机断层血管造影自20世纪90年代以来已成为最常见的诊断方式。总截肢率为14% (95% CI, 11%-17%; I2 = 97%; P < 0.00001)，总死亡率为9% （95% CI, 6%-12%; I2 = 86%; P < 0.00001）。胫骨骨折（近端、中轴、远端和多灶性骨折）与胫骨前动脉损伤（优势比[OR]， 9.23; P < .001）和胫骨后动脉损伤（优势比[OR]， 7.86; P = .005）显著相关。同样，腓骨骨折与胫骨后动脉损伤相关（OR, 7.80; P = 0.004）。骨盆骨折/髋关节脱位与血管损伤之间无显著关联（P > 0.05）。最后，初次血管修复患者的截肢率（19.5%）明显高于初次骨折/脱位复位患者（6.5%;P < .001），而两种治疗顺序之间的死亡率无显著差异（4% vs 3.85%; P < .05）。结论：我们的分析强调了与肌肉骨骼创伤相关的血管损伤的截肢和死亡率的高患病率和不可忽视的比率，以动脉横断为主。
{"title":"Prevalence, diagnostic modalities, amputation rate, and overall mortality of arterial injuries associated with lower limb fractures/dislocations: A systematic review and meta-analysis","authors":"Fabrice Stephane Arroye Betou MD , Ferdinand Nyankoue Mebouinz MD , Kobe Fokalbo Zephanie MD , Wilfried Steve Ndeme Mboussi PhD , Charles Mve Mvondo MD , Aristide Bang MD , Papa Adama Dieng MD , Louis Richard Njock MD","doi":"10.1016/j.jvsvi.2025.100283","DOIUrl":"10.1016/j.jvsvi.2025.100283","url":null,"abstract":"<div><h3>Background</h3><div>Data on the prevalence, diagnostic modalities, management sequence, and mortality associated with lower limb fractures/dislocations vary significantly between studies and often do not account for the impact of arterial injury associated with fractures/dislocations on the risks of ischemia, amputation, and severe disability—posing major therapeutic challenges. Considering these uncertain things, we aimed to determine the prevalence, diagnostic modalities, amputation rate, and overall mortality associated with these injuries.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following the Meta-Analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive literature was performed in Medline, Embase, and the World Health Organization Global Health Library, covering the period from January 1, 1960, to April 2024, with no language restrictions. We included observational studies (cohort studies, cross-sectional studies, case-control studies, and retrospective series) reporting on the prevalence, secondary amputation rate, diagnostic and therapeutic modality techniques, histopathological type of vascular injuries, management sequence, and time to hospital admission in cases of combined vascular and musculoskeletal injuries. Two reviewers independently selected studies and extracted data, and methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled estimates for prevalence, amputation, and mortality rates were calculated using meta-analysis. Heterogeneity was assessed using Cochran’s Q χ<sup>2</sup> test and quantified by the I<sup>2</sup> statistic. All analyses were performed using R software version 4.4.2 for Windows.</div></div><div><h3>Results</h3><div>The global prevalence of vascular injuries associated with musculoskeletal trauma was 37% (95% confidence interval [CI], 25%-49%), with substantial heterogeneity across studies (I<sup>2</sup> = 100%; <em>P</em> < .00001). The most frequently reported vascular injury was arterial transection (complete or partial), found in 278 cases (46.3%). Regarding treatment, open surgery was predominant, with vascular bypass in 56.71% of the lower limb trauma population, far ahead of other techniques. Arteriography was historically the most frequently used diagnostic modality, whereas computed tomography angiography has become the most common since the 1990s. The overall amputation rate was 14% (95% CI, 11%-17%; I<sup>2</sup> = 97%; <em>P</em> < .00001), and the overall mortality rate was 9% (95% CI, 6%-12%; I<sup>2</sup> = 86%; <em>P</em> < .00001). Tibial fractures (proximal, midshaft, distal, and multifocal) were significantly associated with injuries to the anterior tibial artery (odds ratio [OR], 9.23; <em>P</em> < .001) and the posterior tibial artery (OR, 7.86; <em>P</em> = .005). Similarly, fibula fractures were associated with posterior tibial artery injury (OR, 7.80; <em>P</em> = .004)","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100317
Rebecca Scully MD, MPH , Xinyan Zheng MS , Sadia Ilyas MD , Jocelyn Beach MD , Jesse Columbo MD, MS , Philip Goodney MD, MS , Salvatore Scali MD , David Stone MD
Objective
Sex-based outcome disparities have been documented following abdominal aortic aneurysm (AAA) repair; however, the underlying mechanisms driving these findings remain undefined. The purpose of this study was to document whether there are sex-based disparities with postoperative imaging surveillance compliance following endovascular aortic aneurysm repair (EVAR) and, if so, to determine their impact on patient outcomes.
Methods
All patients with Medicare fee-for-service insurance undergoing elective EVAR in the Vascular Quality Initiative (VQI) Medicare-Linked Vascular Implant Surveillance and Interventional Outcomes Network (VISION) from 2010 to 2019 were identified. Patients with intraoperative completion endoleaks were excluded. Surveillance failure was defined as non-compliance with Society for Vascular Surgery guidelines, which recommend follow-up imaging at 30 days, 1 year, and then annually thereafter. Long-term surveillance failure was examined with Kaplan-Meier analysis and Cox proportional hazards models for risk adjustment. We performed a two-step adjustment to examine the mediator effect of surveillance failure on sex-based outcomes.
Results
Over the study interval, 15,008 patients met inclusion criteria. Among this group, 19.1% (n = 2873) were female. Notably, 18% of both male and female patients failed to undergo any surveillance imaging at 30 days post-procedure. Over the longer term, women demonstrated significantly higher rates of imaging failure (unadjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.04-1.22; P = .002). Prior to adjustment, women had a significantly increased risk of death following EVAR compared with men (HR, 1.29; 95% CI, 1.2-1.39; P < .001); however, following the adjustment of all baseline variables, this effect was smaller (HR, 1.08; 95% CI, 0.99-1.17; P = .05). Although imaging failure was an independent risk factor for mortality (HR, 1.25; 95% CI, 1.15-1.36; P < .001), it did not appear to mediate the impact of sex on mortality when added in risk adjustment (HR, 1.08; 95% CI, 0.99-1.17; P = .07).
Conclusions
Durable EVAR outcomes are less likely among women compared with men in current practice. Based on the current results, surveillance failure does not appear to be a mediator of the impact of sex on mortality but may be an independent risk factor for mortality. Although efforts designed to enhance compliance with post procedural imaging surveillance in all patients may be an opportunity to improve current AAA care delivery, it may fail to fully address any ongoing sex-based EVAR outcome disparities.
目的：腹主动脉瘤（AAA）修复后基于性别的结果差异已被记录；然而，推动这些发现的潜在机制仍未明确。本研究的目的是记录血管内动脉瘤修复（EVAR）术后影像学监测依从性是否存在性别差异，如果存在，则确定其对患者预后的影响。方法选取2010 - 2019年在血管质量倡议（VQI）医疗相关血管植入物监测和介入结果网络（VISION）中接受选择性EVAR的所有医疗保险按服务收费保险患者。排除术中完全性内漏患者。监测失败被定义为不遵守血管外科学会指南，该指南建议每30天、1年、之后每年进行随访成像。采用Kaplan-Meier分析和Cox比例风险模型对长期监测失败进行风险调整。我们进行了两步调整来检验监测失败对基于性别的结果的中介效应。结果在研究期间，15,008例患者符合纳入标准。其中女性占19.1% （n = 2873）。值得注意的是，18%的男性和女性患者在术后30天没有接受任何监测成像。从长期来看，女性表现出明显更高的成像失败率（未经调整的风险比[HR]， 1.12； 95%可信区间[CI]， 1.04-1.22; P = .002）。调整前，女性与男性相比，EVAR后死亡风险显著增加（HR, 1.29; 95% CI, 1.2-1.39; P < .001）；然而，在调整所有基线变量后，这种影响较小（HR, 1.08; 95% CI, 0.99-1.17; P = 0.05）。虽然成像失败是死亡率的独立危险因素（HR, 1.25; 95% CI, 1.15-1.36; P < .001），但当加入风险调整因素时，它似乎并没有调节性别对死亡率的影响（HR, 1.08; 95% CI, 0.99-1.17; P = .07）。结论在目前的实践中，女性与男性相比，持久的EVAR结果不太可能出现。根据目前的结果，监测失败似乎不是性别对死亡率影响的中介，但可能是死亡率的一个独立风险因素。尽管旨在提高所有患者术后影像学监测依从性的努力可能是改善当前AAA级护理服务的一个机会，但它可能无法完全解决任何持续的基于性别的EVAR结果差异。
{"title":"Lapses in post-EVAR surveillance compliance fail to account for prior documented sex-based abdominal aortic aneurysm outcome disparities","authors":"Rebecca Scully MD, MPH , Xinyan Zheng MS , Sadia Ilyas MD , Jocelyn Beach MD , Jesse Columbo MD, MS , Philip Goodney MD, MS , Salvatore Scali MD , David Stone MD","doi":"10.1016/j.jvsvi.2025.100317","DOIUrl":"10.1016/j.jvsvi.2025.100317","url":null,"abstract":"<div><h3>Objective</h3><div>Sex-based outcome disparities have been documented following abdominal aortic aneurysm (AAA) repair; however, the underlying mechanisms driving these findings remain undefined. The purpose of this study was to document whether there are sex-based disparities with postoperative imaging surveillance compliance following endovascular aortic aneurysm repair (EVAR) and, if so, to determine their impact on patient outcomes.</div></div><div><h3>Methods</h3><div>All patients with Medicare fee-for-service insurance undergoing elective EVAR in the Vascular Quality Initiative (VQI) Medicare-Linked Vascular Implant Surveillance and Interventional Outcomes Network (VISION) from 2010 to 2019 were identified. Patients with intraoperative completion endoleaks were excluded. Surveillance failure was defined as non-compliance with Society for Vascular Surgery guidelines, which recommend follow-up imaging at 30 days, 1 year, and then annually thereafter. Long-term surveillance failure was examined with Kaplan-Meier analysis and Cox proportional hazards models for risk adjustment. We performed a two-step adjustment to examine the mediator effect of surveillance failure on sex-based outcomes.</div></div><div><h3>Results</h3><div>Over the study interval, 15,008 patients met inclusion criteria. Among this group, 19.1% (n = 2873) were female. Notably, 18% of both male and female patients failed to undergo any surveillance imaging at 30 days post-procedure. Over the longer term, women demonstrated significantly higher rates of imaging failure (unadjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.04-1.22; <em>P</em> = .002). Prior to adjustment, women had a significantly increased risk of death following EVAR compared with men (HR, 1.29; 95% CI, 1.2-1.39; <em>P</em> < .001); however, following the adjustment of all baseline variables, this effect was smaller (HR, 1.08; 95% CI, 0.99-1.17; <em>P</em> = .05). Although imaging failure was an independent risk factor for mortality (HR, 1.25; 95% CI, 1.15-1.36; <em>P</em> < .001), it did not appear to mediate the impact of sex on mortality when added in risk adjustment (HR, 1.08; 95% CI, 0.99-1.17; <em>P</em> = .07).</div></div><div><h3>Conclusions</h3><div>Durable EVAR outcomes are less likely among women compared with men in current practice. Based on the current results, surveillance failure does not appear to be a mediator of the impact of sex on mortality but may be an independent risk factor for mortality. Although efforts designed to enhance compliance with post procedural imaging surveillance in all patients may be an opportunity to improve current AAA care delivery, it may fail to fully address any ongoing sex-based EVAR outcome disparities.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100317"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100251
Ottavia Borghese MD, PhD , Natalia Hara MD , Angelo Pisani MD , Ana Lopez-Marco MD, PhD , Benjamin Adams MD , Aung Ye Oo MD, PhD , Tara M. Mastracci MD, FRCSC, FRCS
Background
Non-A non-B (NANB) aortic dissections (ADs) are uncommon (3%-11% of all ADs), so, frequently, they are unrecognized and classified as type B dissections.
Methods
We reviewed the literature and our own experience to summarize the presentation and treatment of NANB dissection.
Results
Currently defined as a dissection with a primary tear in the arch (Ishimaru zone 1 or 2) or in Ishimaru zone 3 and retrogradely extending into the arch they indicate an heterogenous group of diseases that may deeply differ in terms of clinical and anatomical presentation. Affected patients tend to be younger (57 years vs 65 and 67, years respectively) when compared with type A and B ADs and the clinical presentation and evolution seem to be frequently complicated (≤88% of cases) with signs of malperfusion (29%) or risk of impending rupture (6%). Nonoperative management seems possible in only a small percentage of NANB cases with most patients undergoing intervention in the acute or subacute phase. However, because of the variability of the dissection anatomy and extent, the type and timing of treatment may vary, and there is no standardized treatment pathway. Despite its preferability, anatomical or goal-directed treatment does not yet represent the standard of care. The reported data are heterogenous, and thus it is difficult to compare the outcomes achieved with surgical and endovascular strategies. Taken at face value, the published papers demonstrate that the 30-day mortality rate is increased in patients treated medically vs those who undergo intervention (14.0% vs 3.6%), but populations included in these publications are not comparable: Most studies only focus on a single approach, with small sample sizes and limited detail on the anatomical features of the dissection. When an intervention is needed, several strategies have been adopted so far, including open aortic arch replacement or frozen elephant trunk, thoracic endovascular aortic repair with chimney stent graft or hybrid procedures with surgical rerouting of supra-aortic branches and thoracic endovascular aortic repair. After intervention, the postoperative stroke rate ranges between 0% and 12.5%, and postoperative myocardial infarction is described in up to 2.8%; aortic-related reintervention during follow-up are reported to be up to 43.6% in the operative group.
Conclusions
NANB dissections are complex and can be considered a high-risk presentation of type B dissections. Because of the heterogeneity and the lack of exhaustive data, a prospective study would be pivotal to provide more substantial evidence for the standardize application of surgical/medical approaches in this subgroup of patients for whom immediate and long-term outcomes deeply relay on the selection criteria and radiological findings at the initial onset.
{"title":"Nonoperative and interventional treatment in patients presenting with non-A non-B acute aortic dissection: Current management strategies and clinical outcomes","authors":"Ottavia Borghese MD, PhD , Natalia Hara MD , Angelo Pisani MD , Ana Lopez-Marco MD, PhD , Benjamin Adams MD , Aung Ye Oo MD, PhD , Tara M. Mastracci MD, FRCSC, FRCS","doi":"10.1016/j.jvsvi.2025.100251","DOIUrl":"10.1016/j.jvsvi.2025.100251","url":null,"abstract":"<div><h3>Background</h3><div>Non-A non-B (NANB) aortic dissections (ADs) are uncommon (3%-11% of all ADs), so, frequently, they are unrecognized and classified as type B dissections.</div></div><div><h3>Methods</h3><div>We reviewed the literature and our own experience to summarize the presentation and treatment of NANB dissection.</div></div><div><h3>Results</h3><div>Currently defined as a dissection with a primary tear in the arch (Ishimaru zone 1 or 2) or in Ishimaru zone 3 and retrogradely extending into the arch they indicate an heterogenous group of diseases that may deeply differ in terms of clinical and anatomical presentation. Affected patients tend to be younger (57 years vs 65 and 67, years respectively) when compared with type A and B ADs and the clinical presentation and evolution seem to be frequently complicated (≤88% of cases) with signs of malperfusion (29%) or risk of impending rupture (6%). Nonoperative management seems possible in only a small percentage of NANB cases with most patients undergoing intervention in the acute or subacute phase. However, because of the variability of the dissection anatomy and extent, the type and timing of treatment may vary, and there is no standardized treatment pathway. Despite its preferability, anatomical or goal-directed treatment does not yet represent the standard of care. The reported data are heterogenous, and thus it is difficult to compare the outcomes achieved with surgical and endovascular strategies. Taken at face value, the published papers demonstrate that the 30-day mortality rate is increased in patients treated medically vs those who undergo intervention (14.0% vs 3.6%), but populations included in these publications are not comparable: Most studies only focus on a single approach, with small sample sizes and limited detail on the anatomical features of the dissection. When an intervention is needed, several strategies have been adopted so far, including open aortic arch replacement or frozen elephant trunk, thoracic endovascular aortic repair with chimney stent graft or hybrid procedures with surgical rerouting of supra-aortic branches and thoracic endovascular aortic repair. After intervention, the postoperative stroke rate ranges between 0% and 12.5%, and postoperative myocardial infarction is described in up to 2.8%; aortic-related reintervention during follow-up are reported to be up to 43.6% in the operative group.</div></div><div><h3>Conclusions</h3><div>NANB dissections are complex and can be considered a high-risk presentation of type B dissections. Because of the heterogeneity and the lack of exhaustive data, a prospective study would be pivotal to provide more substantial evidence for the standardize application of surgical/medical approaches in this subgroup of patients for whom immediate and long-term outcomes deeply relay on the selection criteria and radiological findings at the initial onset.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsvi.2025.100246
Mohammad Hamzah BS , Fatima Al-Maaz BS , Ahmad Chalhoub BS , Rita Nemr MD
Background
Thoracic aortic aneurysms (TAA) and aortic dissections (AD) are recognized as one of the leading causes of death in developed countries. Although mortality decreases if at-risk individuals are diagnosed early, on thorough screening, many fail to seek the proper preventive interventions timely. Genetic predisposition, smoking, and hypertension are well-known risk factors for highly lethal aortic aneurysmal rupture or dissection. Hypothyroidism has also been described extensively in the literature as a possible risk factor directly related to the origin of TAA and dissection. Numerous studies have proposed a pathophysiological role for hypothyroidism in the development of TAA and AD, although this role is still not fully understood. This scoping review sought human and animal studies to examine the relationship between hypothyroidism and thoracic aortic diseases.
Methods
A search in PubMed, Web of Science, and Scopus using the terms “aortic dissection,” “aorta,” “aortic aneurysm,” and “hypothyroidism” yielded 907 articles, although only 9 were relevant to this study topic and criteria.
Results
The included articles discuss thoracic aortic diseases as potential risk factors for TAA and dissection. A low thyroid hormone level might be a negative prognostic indicator after acute AD.
Conclusions
Establishing a link between hypothyroidism and thoracic aortic diseases could improve clinical practice through the development of screening strategies for thyroid function in patients with thoracic aortic diseases, thereby reducing postoperative mortality rates.
背景胸主动脉瘤（TAA）和主动脉夹层（AD）是发达国家公认的主要死亡原因之一。尽管在进行彻底筛查的情况下，如果高危人群得到早期诊断，死亡率会降低，但许多人未能及时寻求适当的预防干预措施。众所周知，遗传易感性、吸烟和高血压是导致高致命性主动脉瘤破裂或夹层的危险因素。甲状腺功能减退在文献中也被广泛描述为与TAA和夹层的起源直接相关的可能的危险因素。许多研究已经提出了甲状腺功能减退在TAA和AD发展中的病理生理作用，尽管这种作用仍未完全了解。本综述通过人类和动物研究来研究甲状腺功能减退和胸主动脉疾病之间的关系。方法在PubMed、Web of Science和Scopus中搜索“主动脉夹层”、“主动脉”、“主动脉瘤”和“甲状腺功能减退”，得到907篇文章，尽管只有9篇与本研究主题和标准相关。结果纳入的文章讨论了胸主动脉疾病是TAA和夹层的潜在危险因素。低甲状腺激素水平可能是急性AD后的一个阴性预后指标。结论通过制定胸主动脉疾病患者甲状腺功能筛查策略，建立甲状腺功能减退与胸主动脉疾病之间的联系，可以改善临床实践，从而降低术后死亡率。
{"title":"A narrative review exploring the association between hypothyroidism and thoracic aortic diseases","authors":"Mohammad Hamzah BS , Fatima Al-Maaz BS , Ahmad Chalhoub BS , Rita Nemr MD","doi":"10.1016/j.jvsvi.2025.100246","DOIUrl":"10.1016/j.jvsvi.2025.100246","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic aortic aneurysms (TAA) and aortic dissections (AD) are recognized as one of the leading causes of death in developed countries. Although mortality decreases if at-risk individuals are diagnosed early, on thorough screening, many fail to seek the proper preventive interventions timely. Genetic predisposition, smoking, and hypertension are well-known risk factors for highly lethal aortic aneurysmal rupture or dissection. Hypothyroidism has also been described extensively in the literature as a possible risk factor directly related to the origin of TAA and dissection. Numerous studies have proposed a pathophysiological role for hypothyroidism in the development of TAA and AD, although this role is still not fully understood. This scoping review sought human and animal studies to examine the relationship between hypothyroidism and thoracic aortic diseases.</div></div><div><h3>Methods</h3><div>A search in PubMed, Web of Science, and Scopus using the terms “aortic dissection,” “aorta,” “aortic aneurysm,” and “hypothyroidism” yielded 907 articles, although only 9 were relevant to this study topic and criteria.</div></div><div><h3>Results</h3><div>The included articles discuss thoracic aortic diseases as potential risk factors for TAA and dissection. A low thyroid hormone level might be a negative prognostic indicator after acute AD.</div></div><div><h3>Conclusions</h3><div>Establishing a link between hypothyroidism and thoracic aortic diseases could improve clinical practice through the development of screening strategies for thyroid function in patients with thoracic aortic diseases, thereby reducing postoperative mortality rates.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100246"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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