Pub Date : 2025-09-30DOI: 10.1016/j.jvsvi.2025.100308
Darwin Eton MD, FACS, DFSVS
{"title":"Wake up! This is the 21st century!","authors":"Darwin Eton MD, FACS, DFSVS","doi":"10.1016/j.jvsvi.2025.100308","DOIUrl":"10.1016/j.jvsvi.2025.100308","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651950","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.2025.100221
Dirk A. Le Roux MBChB(Pret), FCS(SA), CVS(SA) , Pradeep P. Mistry MBChB(Pret), MMed Surgery(Pret), FCS(SA), CVS(SA) , Lewis J. Levien MBBCh, FCS(SA), PhD(MED) , Hideaki Obara MD, PhD , Rahul Agarwal MBBS, DNB(General Surgery), DrNB(Vascular Surgery)
Popliteal artery adventitial disease (PAAD) underlies a significant portion of vascular conditions of the lower extremities, often culminating in critical limb ischemia and warranting a greater clinical understanding for effective management. Characterized by the cystic degeneration of the adventitia of the popliteal artery, PAAD remains a challenging condition both in terms of diagnosis and treatment. This review seeks to explore the complex pathophysiology, diagnostic criteria, and current management strategies, as well as discussing emerging therapies and future outlook for patients with PAAD.
{"title":"Popliteal artery adventitial disease: A case report and understanding the pathophysiology and management","authors":"Dirk A. Le Roux MBChB(Pret), FCS(SA), CVS(SA) , Pradeep P. Mistry MBChB(Pret), MMed Surgery(Pret), FCS(SA), CVS(SA) , Lewis J. Levien MBBCh, FCS(SA), PhD(MED) , Hideaki Obara MD, PhD , Rahul Agarwal MBBS, DNB(General Surgery), DrNB(Vascular Surgery)","doi":"10.1016/j.jvsvi.2025.100221","DOIUrl":"10.1016/j.jvsvi.2025.100221","url":null,"abstract":"<div><div>Popliteal artery adventitial disease (PAAD) underlies a significant portion of vascular conditions of the lower extremities, often culminating in critical limb ischemia and warranting a greater clinical understanding for effective management. Characterized by the cystic degeneration of the adventitia of the popliteal artery, PAAD remains a challenging condition both in terms of diagnosis and treatment. This review seeks to explore the complex pathophysiology, diagnostic criteria, and current management strategies, as well as discussing emerging therapies and future outlook for patients with PAAD.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069382","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.2025.100223
Bhagwan Satiani MD, MBA, DFSVS, FACHE, FACS , Jessica L. Bailey–Wheaton JD , Todd A. Zigrang MBA, MHA, FACHE, CVA, ASA , Hiranya A. Rajasinghe MD, FACS
Objective
Private Equity (PE) investors have been rapidly expanding their presence in the health care industry, including investments in physician practices, asserting that this will benefit patients, physicians, and the health care system.
Methods
We summarize the literature related to PE partnering with physicians, discuss the pros and cons, illustrate the financial implications through a case study, and offer glimpses into the future clouded by governmental pushback.
Results
In a time of increasing regulatory burdens and decreasing reimbursement, PE offers vascular surgeons (VS) options for private practice, and corporate employment. PE contends that this relationship adds value by reducing inefficiencies and waste, and the capital infusion allows procurement of the latest technology and tools for better outcomes. Furthermore, PE management will negotiate with insurance companies to increase reimbursement, manage human resources tasks, billing, and accounting and allow the VS to concentrate on quality patient care. Management will also prepare the practice for new models of care (eg, whether value-based reimbursement or accountable care organizations). PE projects to expand market share and have VS partners share profits, based on a formula, when the entity is later sold to another buyer in the future.
Conclusions
Although there may be some advantages for VS to partner with PE entities, it may not be ideal for all career stages and requires considerable expertise in negotiations and vigilance for unfavorable regulatory actions.
{"title":"Role of private equity in vascular care","authors":"Bhagwan Satiani MD, MBA, DFSVS, FACHE, FACS , Jessica L. Bailey–Wheaton JD , Todd A. Zigrang MBA, MHA, FACHE, CVA, ASA , Hiranya A. Rajasinghe MD, FACS","doi":"10.1016/j.jvsvi.2025.100223","DOIUrl":"10.1016/j.jvsvi.2025.100223","url":null,"abstract":"<div><h3>Objective</h3><div>Private Equity (PE) investors have been rapidly expanding their presence in the health care industry, including investments in physician practices, asserting that this will benefit patients, physicians, and the health care system.</div></div><div><h3>Methods</h3><div>We summarize the literature related to PE partnering with physicians, discuss the pros and cons, illustrate the financial implications through a case study, and offer glimpses into the future clouded by governmental pushback.</div></div><div><h3>Results</h3><div>In a time of increasing regulatory burdens and decreasing reimbursement, PE offers vascular surgeons (VS) options for private practice, and corporate employment. PE contends that this relationship adds value by reducing inefficiencies and waste, and the capital infusion allows procurement of the latest technology and tools for better outcomes. Furthermore, PE management will negotiate with insurance companies to increase reimbursement, manage human resources tasks, billing, and accounting and allow the VS to concentrate on quality patient care. Management will also prepare the practice for new models of care (eg, whether value-based reimbursement or accountable care organizations). PE projects to expand market share and have VS partners share profits, based on a formula, when the entity is later sold to another buyer in the future.</div></div><div><h3>Conclusions</h3><div>Although there may be some advantages for VS to partner with PE entities, it may not be ideal for all career stages and requires considerable expertise in negotiations and vigilance for unfavorable regulatory actions.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069381","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}
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is defined as superior mesenteric artery (SMA) dissection without the presence of aortic dissection. SISMAD can be asymptomatic or present with acute abdominal pain. Diagnosis is usually by computed tomography angiography (CTA). The exact etiology of SISMAD is not known. Atherosclerosis, hypertension, and high convexity of SMA have been implicated in the development of SISMAD. The majority can be managed by conservative measures. Endovascular stenting is advised when medical management fails. Open surgery has a limited role in this condition. Nonspecific large vessel vasculitis can cause inflammation around the visceral aorta, celiac artery, and SMA, leading to dissection in these vessels. Recognizing mesenteric artery vasculitis as a potential cause of abdominal pain can be challenging. Usually, they show only elevated nonspecific inflammatory markers and no features of systemic vasculitis. Addition of steroids can help to resolve the inflammation and avoid unnecessary intervention.
Methods
We are reporting here of a successful conservative management of a 55-year-old male patient with SISMAD due to isolated large vessel vasculitis involving the SMA. He had no systemic vasculitis, and the CTA showed typical features of SMA vasculitis and dissection. In addition to traditional medical management, he was given an infusion of methyl prednisolone followed by oral steroids.
Results
He had complete relief of symptoms and was discharged after 5 days. Follow-up CTA showed flow in the true lumen though the true lumen showed stenosis.
Conclusions
Isolated mesenteric artery vasculitis without systemic involvement is rarely reported in the literature, which can be the cause for dissection not being recognized. Patients diagnosed with SISMAD should undergo routine checks for inflammatory markers and vasculitis. If the markers are high, steroids may be added to the conservative measures to reduce the inflammation, which can help in remodeling of the SMA and thereby improving the outcome. The majority of patients with SISMAD could be initially managed by medical treatment. Persistent pain and fear of missing the diagnosis of bowel ischemia have been the most important causes for early conversion to intervention. The addition of a short course of steroids, especially for those with elevated inflammatory markers, can help in early resolution of the inflammation with relief of pain. This would help to avoid unnecessary intervention.
{"title":"Spontaneous superior mesenteric artery dissection due to idiopathic large vessel vasculitis-report of a case and review of the literature","authors":"Natarajan Sekar MS, MNAMS, MCh (Vascular Surgery), DSc, FRCS (Glas) , Rohit Mehra MS, DrNB (Peripheral vascular Surgery), FACS , Prem Chand Gupta MS","doi":"10.1016/j.jvsvi.2025.100224","DOIUrl":"10.1016/j.jvsvi.2025.100224","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous isolated superior mesenteric artery dissection (SISMAD) is defined as superior mesenteric artery (SMA) dissection without the presence of aortic dissection. SISMAD can be asymptomatic or present with acute abdominal pain. Diagnosis is usually by computed tomography angiography (CTA). The exact etiology of SISMAD is not known. Atherosclerosis, hypertension, and high convexity of SMA have been implicated in the development of SISMAD. The majority can be managed by conservative measures. Endovascular stenting is advised when medical management fails. Open surgery has a limited role in this condition. Nonspecific large vessel vasculitis can cause inflammation around the visceral aorta, celiac artery, and SMA, leading to dissection in these vessels. Recognizing mesenteric artery vasculitis as a potential cause of abdominal pain can be challenging. Usually, they show only elevated nonspecific inflammatory markers and no features of systemic vasculitis. Addition of steroids can help to resolve the inflammation and avoid unnecessary intervention.</div></div><div><h3>Methods</h3><div>We are reporting here of a successful conservative management of a 55-year-old male patient with SISMAD due to isolated large vessel vasculitis involving the SMA. He had no systemic vasculitis, and the CTA showed typical features of SMA vasculitis and dissection. In addition to traditional medical management, he was given an infusion of methyl prednisolone followed by oral steroids.</div></div><div><h3>Results</h3><div>He had complete relief of symptoms and was discharged after 5 days. Follow-up CTA showed flow in the true lumen though the true lumen showed stenosis.</div></div><div><h3>Conclusions</h3><div>Isolated mesenteric artery vasculitis without systemic involvement is rarely reported in the literature, which can be the cause for dissection not being recognized. Patients diagnosed with SISMAD should undergo routine checks for inflammatory markers and vasculitis. If the markers are high, steroids may be added to the conservative measures to reduce the inflammation, which can help in remodeling of the SMA and thereby improving the outcome. The majority of patients with SISMAD could be initially managed by medical treatment. Persistent pain and fear of missing the diagnosis of bowel ischemia have been the most important causes for early conversion to intervention. The addition of a short course of steroids, especially for those with elevated inflammatory markers, can help in early resolution of the inflammation with relief of pain. This would help to avoid unnecessary intervention.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070689","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.2025.100226
Rathnaganpathi Thulasikumar Dr med , Manoj Prabakar Ravichandran Dr med , Ferdinand Tamoue PhD , Thulasikumar Ganapathy Dr med
Background
Varicose vein is a progressive disease that does not have remission except after pregnancy and delivery. It is a type of venous insufficiency that presents with dilated, tortuous, elongated veins owing to the permanent loss of the valvular efficiency. The aim of the study is to demonstrate the health care professionals can consistently achieve a sub-bandage interface pressure of 30 ± 10 mm Hg using an Elastic Crepe Bandage, ECB-394, or its derivatives, which has similar viscoelastic properties, to treat patients with varicose veins.
Methods
This study was conducted among the varicose vein patients attending Sree Parthas Multispecialty Hospital and the Department of Vascular Surgery over a period of 3 months. Patients were screened for the study from November 2023 to February 2024. Based on the inclusion and exclusion criteria, study participants were recruited. The final sample size was 35. Demographic details were recorded. Sub-bandage pressure was measured with the Pico Press sensor. The data collected were entered in Excel Sheet and analysis were done by SPSS 23. A P value of less than .05 was considered as statistically significant.
Results
The mean age of the study participants was 42.37 ± 12.09 years, with a minimum age of 22 years and a maximum of 72 years. Males were predominant in our study, accounting for 27 participants (77.1%). Systemic hypertension, present in six patients (17.1%), was the most common comorbidity. A statistically significant difference was observed between the initial and final pressure measurements. Compliance and safety were found to be 100% among the study participants. Efficacy was observed in 80% of the participants, although adherence was only noted in 60%.
Conclusions
The study demonstrates the effectiveness and safety of the intervention, with a high compliance rate and a statistically significant improvement in pressure outcomes. However, adherence remains a key area for further improvement.
{"title":"Ex vivo evaluation of the clinical performance of an elastic crepe or support bandage for the treatment of varicose veins","authors":"Rathnaganpathi Thulasikumar Dr med , Manoj Prabakar Ravichandran Dr med , Ferdinand Tamoue PhD , Thulasikumar Ganapathy Dr med","doi":"10.1016/j.jvsvi.2025.100226","DOIUrl":"10.1016/j.jvsvi.2025.100226","url":null,"abstract":"<div><h3>Background</h3><div>Varicose vein is a progressive disease that does not have remission except after pregnancy and delivery. It is a type of venous insufficiency that presents with dilated, tortuous, elongated veins owing to the permanent loss of the valvular efficiency. The aim of the study is to demonstrate the health care professionals can consistently achieve a sub-bandage interface pressure of 30 ± 10 mm Hg using an Elastic Crepe Bandage, ECB-394, or its derivatives, which has similar viscoelastic properties, to treat patients with varicose veins.</div></div><div><h3>Methods</h3><div>This study was conducted among the varicose vein patients attending Sree Parthas Multispecialty Hospital and the Department of Vascular Surgery over a period of 3 months. Patients were screened for the study from November 2023 to February 2024. Based on the inclusion and exclusion criteria, study participants were recruited. The final sample size was 35. Demographic details were recorded. Sub-bandage pressure was measured with the Pico Press sensor. The data collected were entered in Excel Sheet and analysis were done by SPSS 23. A <em>P</em> value of less than .05 was considered as statistically significant.</div></div><div><h3>Results</h3><div>The mean age of the study participants was 42.37 ± 12.09 years, with a minimum age of 22 years and a maximum of 72 years. Males were predominant in our study, accounting for 27 participants (77.1%). Systemic hypertension, present in six patients (17.1%), was the most common comorbidity. A statistically significant difference was observed between the initial and final pressure measurements. Compliance and safety were found to be 100% among the study participants. Efficacy was observed in 80% of the participants, although adherence was only noted in 60%.</div></div><div><h3>Conclusions</h3><div>The study demonstrates the effectiveness and safety of the intervention, with a high compliance rate and a statistically significant improvement in pressure outcomes. However, adherence remains a key area for further improvement.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070700","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.2024.100169
Trisha L. Roy MD, PhD
{"title":"Plumber, scientist, entrepreneur, teacher: can one really do all?","authors":"Trisha L. Roy MD, PhD","doi":"10.1016/j.jvsvi.2024.100169","DOIUrl":"10.1016/j.jvsvi.2024.100169","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135724","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.2024.100154
Antonio Solano MD , Alejandro Pizano MD , Bala Ramanan MBBS, MS , Michael C. Siah MD , Khalil Chamseddin MD , Gerardo Gonzalez-Guardiola MD , Vivek Prakash MD , Michael Shih MD , M. Shadman Baig MD , Carlos H. Timaran MD , Jeffrey Guild PhD , Melissa L. Kirkwood MD
Objective
Protective garments are part of the routine radiation safety equipment used during fluoroscopically guided interventions (FGIs). New elements and lead equivalences have been introduced by manufacturers, which may influence protection for interventionalists from ionizing radiation. We sought to determine the performance of different lead-equivalent apron vests during FGIs in clinical and simulated scenarios.
Methods
Our primary endpoint was to evaluate the effectiveness of radiation dose attenuation of two different protective leaded apron vests, one with nominal 0.5-mm lead equivalence and a second with 0.35-mm lead equivalence, which were evaluated in clinical and simulated settings. In the clinical setting, optically stimulated luminescence nanoDot™ detectors were placed at the upper outer quadrant (UOQ) chest wall (CW) position, both over and under the apron vests on one vascular surgeon performing FGIs over a 21-month period. All interventions were performed in hybrid rooms with Allura Clarity (Phillips Healthcare) C-arms with state of-the-art software for vessel navigation, digital subtraction angiography, digital magnification, and collimation. Dosimeters were placed on either side of the primary operator’s body, located on the side closest to the X-ray source. In the simulation, fluorography was performed on a 30-inch-thick acrylic scatter phantom at 68, 80, 100, and 120 kVp for an exposure of 2000 mGy reference air kerma. Experiments were performed on the 0.35-mm and 0.5-mm lead-equivalent aprons. Paired Wilcoxon, χ2, and analysis of variance tests were performed to identify statistical significance of radiation attenuation dose rates.
Results
Operator UOQ CW radiation dose was measured during 32 FGIs: 16 were performed with the 0.5-mm lead-equivalent apron and 16 with the 0.35-mm lead-equivalent apron. Median procedure reference air kerma was 167 mGy (interquartile range, 99-437 mGy) when the 0.5-mm apron vest was worn vs 250 mGy (interquartile range, 144-410 mGy) with the 0.35-mm vest. There was no significant difference in UOQ CW radiation dose attenuation between the two lead equivalencies: thick 89% vs thin 86%; P = .2. In the simulated scenario, radiation dose attenuation was similar for all measured kVp, with no significant differences for both apron vests (94% thick vs 95% thin; P = .49).
Conclusions
Heavier leaded aprons do not offer clinically significant increased protection over thinner lead. Due to the long-term musculoskeletal strain on interventionalists, it is safe to consider lightweight lead protection.
{"title":"0.35-mm lead-equivalent aprons provide similar protection to interventionalists compared to 0.5-mm lead-equivalent aprons during fluoroscopically guided interventions","authors":"Antonio Solano MD , Alejandro Pizano MD , Bala Ramanan MBBS, MS , Michael C. Siah MD , Khalil Chamseddin MD , Gerardo Gonzalez-Guardiola MD , Vivek Prakash MD , Michael Shih MD , M. Shadman Baig MD , Carlos H. Timaran MD , Jeffrey Guild PhD , Melissa L. Kirkwood MD","doi":"10.1016/j.jvsvi.2024.100154","DOIUrl":"10.1016/j.jvsvi.2024.100154","url":null,"abstract":"<div><h3>Objective</h3><div>Protective garments are part of the routine radiation safety equipment used during fluoroscopically guided interventions (FGIs). New elements and lead equivalences have been introduced by manufacturers, which may influence protection for interventionalists from ionizing radiation. We sought to determine the performance of different lead-equivalent apron vests during FGIs in clinical and simulated scenarios.</div></div><div><h3>Methods</h3><div>Our primary endpoint was to evaluate the effectiveness of radiation dose attenuation of two different protective leaded apron vests, one with nominal 0.5-mm lead equivalence and a second with 0.35-mm lead equivalence, which were evaluated in clinical and simulated settings. In the clinical setting, optically stimulated luminescence nanoDot™ detectors were placed at the upper outer quadrant (UOQ) chest wall (CW) position, both over and under the apron vests on one vascular surgeon performing FGIs over a 21-month period. All interventions were performed in hybrid rooms with Allura Clarity (Phillips Healthcare) C-arms with state of-the-art software for vessel navigation, digital subtraction angiography, digital magnification, and collimation. Dosimeters were placed on either side of the primary operator’s body, located on the side closest to the X-ray source. In the simulation, fluorography was performed on a 30-inch-thick acrylic scatter phantom at 68, 80, 100, and 120 kVp for an exposure of 2000 mGy reference air kerma. Experiments were performed on the 0.35-mm and 0.5-mm lead-equivalent aprons. Paired Wilcoxon, χ<sup>2</sup>, and analysis of variance tests were performed to identify statistical significance of radiation attenuation dose rates.</div></div><div><h3>Results</h3><div>Operator UOQ CW radiation dose was measured during 32 FGIs: 16 were performed with the 0.5-mm lead-equivalent apron and 16 with the 0.35-mm lead-equivalent apron. Median procedure reference air kerma was 167 mGy (interquartile range, 99-437 mGy) when the 0.5-mm apron vest was worn vs 250 mGy (interquartile range, 144-410 mGy) with the 0.35-mm vest. There was no significant difference in UOQ CW radiation dose attenuation between the two lead equivalencies: thick 89% vs thin 86%; <em>P</em> = .2. In the simulated scenario, radiation dose attenuation was similar for all measured kVp, with no significant differences for both apron vests (94% thick vs 95% thin; <em>P</em> = .49).</div></div><div><h3>Conclusions</h3><div>Heavier leaded aprons do not offer clinically significant increased protection over thinner lead. Due to the long-term musculoskeletal strain on interventionalists, it is safe to consider lightweight lead protection.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135728","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.2025.100208
Catherine Boudreau MD , Graham McClure MD, MSc , Julien D’Astous MD , Kamil Polok MD, PhD , Jakub Fronczek MD, PhD , Augustin Toma MD , Stephen Yang MD, MSc , Fadi Elias MD, MSc , Wojciech Szczeklik MD, PhD , Emmanuelle Duceppe MD, PhD
Objective
Randomized controlled trials (RCTs) have shown a reduction in short-term mortality with endovascular aneurysm repair (EVAR) compared with open surgical repair (OSR) but failed to demonstrate a long-term mortality advantage. Our study aims to determine whether this loss of mortality benefit could be attributed to differences in cardiovascular events.
Methods
We searched MEDLINE, PubMed, Embase, and Web of Science for RCTs comparing EVAR and OSR for abdominal aortic aneurysm treatment. Title and abstracts, full texts, and study quality were assessed by two independent reviewers. Risk of bias was assessed using the Cochrane Collaboration tool for RCTs. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random-effects method, and heterogeneity was assessed using the I2 statistics.
Results
Our search identified 5204 manuscripts, of which 99 full texts were screened, and 40 manuscripts included. Nine individual RCTs met the eligibility criteria. Inter-rater agreement was excellent for final study inclusion (k = 0.88). Overall, the risk of bias was low. Patients treated with EVAR had a significantly lower short-term mortality (RR: 0.65, 95% CI: 0.43-0.99). The totality of evidence on cardiovascular mortality (3 studies; 1265 patients, RR: 0.61, 95% CI: 0.16-2.25) did not rule out large differences in mortality in either direction. There were no statistically significant differences in long-term all-cause mortality (6 studies; 3436 patients, RR: 1.00, 95% CI: 0.95-1.06) and cardiovascular mortality (4 studies; 3097 patients, RR 1.09, 95% CI: 0.92-1.30), although for the later, the point estimate shifted in the other direction.
Conclusions
Postoperative cardiovascular complications are frequent after abdominal aortic aneurysm repair, and most events are asymptomatic. More data are needed to inform whether the loss of mortality benefit at long-term follow-up with EVAR compared with OSR could be explained by prognostically important undetected cardiac events.
{"title":"Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair","authors":"Catherine Boudreau MD , Graham McClure MD, MSc , Julien D’Astous MD , Kamil Polok MD, PhD , Jakub Fronczek MD, PhD , Augustin Toma MD , Stephen Yang MD, MSc , Fadi Elias MD, MSc , Wojciech Szczeklik MD, PhD , Emmanuelle Duceppe MD, PhD","doi":"10.1016/j.jvsvi.2025.100208","DOIUrl":"10.1016/j.jvsvi.2025.100208","url":null,"abstract":"<div><h3>Objective</h3><div>Randomized controlled trials (RCTs) have shown a reduction in short-term mortality with endovascular aneurysm repair (EVAR) compared with open surgical repair (OSR) but failed to demonstrate a long-term mortality advantage. Our study aims to determine whether this loss of mortality benefit could be attributed to differences in cardiovascular events.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, PubMed, Embase, and Web of Science for RCTs comparing EVAR and OSR for abdominal aortic aneurysm treatment. Title and abstracts, full texts, and study quality were assessed by two independent reviewers. Risk of bias was assessed using the Cochrane Collaboration tool for RCTs. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random-effects method, and heterogeneity was assessed using the <em>I</em><sup>2</sup> statistics.</div></div><div><h3>Results</h3><div>Our search identified 5204 manuscripts, of which 99 full texts were screened, and 40 manuscripts included. Nine individual RCTs met the eligibility criteria. Inter-rater agreement was excellent for final study inclusion (<em>k</em> = 0.88). Overall, the risk of bias was low. Patients treated with EVAR had a significantly lower short-term mortality (RR: 0.65, 95% CI: 0.43-0.99). The totality of evidence on cardiovascular mortality (3 studies; 1265 patients, RR: 0.61, 95% CI: 0.16-2.25) did not rule out large differences in mortality in either direction. There were no statistically significant differences in long-term all-cause mortality (6 studies; 3436 patients, RR: 1.00, 95% CI: 0.95-1.06) and cardiovascular mortality (4 studies; 3097 patients, RR 1.09, 95% CI: 0.92-1.30), although for the later, the point estimate shifted in the other direction.</div></div><div><h3>Conclusions</h3><div>Postoperative cardiovascular complications are frequent after abdominal aortic aneurysm repair, and most events are asymptomatic. More data are needed to inform whether the loss of mortality benefit at long-term follow-up with EVAR compared with OSR could be explained by prognostically important undetected cardiac events.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808271","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}
This study aimed to evaluate the midterm outcomes of aortic remodeling, clinical results, and reinterventions following the use of physician-modified endografts (PMEGs) in patients with post dissection thoracoabdominal aneurysms (PD-TAAAs).
Methods
From January 1, 2017, to December 31, 2020, a cohort of 62 patients underwent fenestrated and branched endovascular aortic repair with PMEGs for residual type A and type B aortic dissection. The true lumen (TL) diameter and false lumen statues were assessed at four aortic levels. Data on aortic remodeling, survival rate, and reintervention were collected and analyzed.
Results
Among the 62 patients treated with PMEGs, the overall survival rate and the freedom from reintervention were 94.5% and 79.4% at 5 years, respectively. The mean TL diameter at four levels before surgery was 27.09 ± 4.65 mm, 23.16 ± 5.58 mm, 18.04 ± 4.64 mm, and 15.41 ± 6.79 mm, respectively. The mean diameter of the TL at four levels after 1-year follow-up was 29.3 ± 4.92 mm, 27.47 ± 5.46 mm, 21.79 ± 3.62 mm, and 19.10 ± 4.41 mm, respectively, showing significant increase in TL diameter at all levels (P ≤ .05). The mean follow-up was 5.09 ± 0.71 years, with an overall survival rate of 96.4% (95% confidence interval [CI], 85.9%-99.1%) at 1 year and 94.5% (95% CI, 84.0%-98.2%) at 5 years. The freedom from reintervention rate was 92.7% (95% CI, 81.8%-97.2%) at 1 year and 79.4% (95% CI, 79.4%-96.0%) at 5 years.
Conclusions
PMEGs for chronic dissection TAAAs can complete entry tears exclusion, resulting in satisfactory results. Aortic remodeling is favorable at the downstream aorta. Comprehensive pre-planning and strict follow-up protocol should be adopted to guarantee long-term outcomes.
{"title":"Aortic remodeling and survival for chronic post dissection thoracoabdominal aneurysm following physician-modified endograft","authors":"Guangmin Yang MD , Yuang Jiang MD , Guangjin Gao MD , Guangyan Wu MD , Yepeng Zhang MD , Min Zhou PhD","doi":"10.1016/j.jvsvi.2025.100195","DOIUrl":"10.1016/j.jvsvi.2025.100195","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the midterm outcomes of aortic remodeling, clinical results, and reinterventions following the use of physician-modified endografts (PMEGs) in patients with post dissection thoracoabdominal aneurysms (PD-TAAAs).</div></div><div><h3>Methods</h3><div>From January 1, 2017, to December 31, 2020, a cohort of 62 patients underwent fenestrated and branched endovascular aortic repair with PMEGs for residual type A and type B aortic dissection. The true lumen (TL) diameter and false lumen statues were assessed at four aortic levels. Data on aortic remodeling, survival rate, and reintervention were collected and analyzed.</div></div><div><h3>Results</h3><div>Among the 62 patients treated with PMEGs, the overall survival rate and the freedom from reintervention were 94.5% and 79.4% at 5 years, respectively. The mean TL diameter at four levels before surgery was 27.09 ± 4.65 mm, 23.16 ± 5.58 mm, 18.04 ± 4.64 mm, and 15.41 ± 6.79 mm, respectively. The mean diameter of the TL at four levels after 1-year follow-up was 29.3 ± 4.92 mm, 27.47 ± 5.46 mm, 21.79 ± 3.62 mm, and 19.10 ± 4.41 mm, respectively, showing significant increase in TL diameter at all levels (<em>P</em> ≤ .05). The mean follow-up was 5.09 ± 0.71 years, with an overall survival rate of 96.4% (95% confidence interval [CI], 85.9%-99.1%) at 1 year and 94.5% (95% CI, 84.0%-98.2%) at 5 years. The freedom from reintervention rate was 92.7% (95% CI, 81.8%-97.2%) at 1 year and 79.4% (95% CI, 79.4%-96.0%) at 5 years.</div></div><div><h3>Conclusions</h3><div>PMEGs for chronic dissection TAAAs can complete entry tears exclusion, resulting in satisfactory results. Aortic remodeling is favorable at the downstream aorta. Comprehensive pre-planning and strict follow-up protocol should be adopted to guarantee long-term outcomes.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511448","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.2025.100216
Alisha Roberta Oropallo MD , Amit Rao MD , Jo Ann Eisinger PA , Larry Leonardi PhD
Background
The adoption of minimally invasive techniques for treating chronic venous insufficiency has surged. Techniques such as foam sclerotherapy and radiofrequency ablation (RFA) are now widely used to address incompetent great saphenous veins. Duplex ultrasound examination has become the gold standard for diagnosing venous insufficiency and evaluating the effectiveness of these treatments. However, venous reflux ultrasound studies remain some of the most time-consuming tasks to obtain.
Objective
The objective of this study was to evaluate the effectiveness of minimally invasive vascular interventions, such as foam sclerotherapy and/or RFA, using mobile multispectral near-infrared spectroscopic (NIRS) imaging. By measuring changes in tissue oxygenation (StO2) before and after treatment, this study aims to provide insights into the utility of NIRS imaging as a noninvasive tool for assessing treatment outcomes.
Methods
This quasi-experimental pre-post-test design study included 14 patients treated for chronic venous insufficiency with either foam sclerotherapy or RFA between November 2022 and February 2024. The patient population presented with significant great saphenous vein insufficiency and normal deep venous pathology, with no evidence of deep vein thrombosis or superficial vein thrombosis, except for one case with partial chronic and deep venous thrombosis. NIRS images of the lower extremities were collected before and immediately after the treatment. The images were acquired from various anatomical locations including the dorsum and plantar aspects of the foot, the medial and lateral leg, and the wound area if present.
Results
The results demonstrated a statistically significant increase in mean StO2 in lower extremities after foam sclerotherapy and RFA, indicating an improved microcirculatory function in the treated limb. These improvements in StO2 in the lower extremities were consistent with the vascular examination results, which confirmed successful vein ablation or closure.
Conclusions
The study demonstrates that NIRS imaging effectively tracks treatment-related changes, providing a noninvasive and reliable method for the real-time assessment of StO2. By visualizing changes in microcirculation, this technology offers clinicians valuable insights, enabling earlier detection of treatment success or failure and facilitating timely interventions. As such, NIRS imaging holds promise as a valuable tool in clinical practice for evaluating the efficacy of minimally invasive vascular treatments. However, the small sample size limits the ability to draw definitive conclusions.
{"title":"Efficacy of minimally invasive vascular interventions assessed with mobile multispectral near-infrared spectroscopy","authors":"Alisha Roberta Oropallo MD , Amit Rao MD , Jo Ann Eisinger PA , Larry Leonardi PhD","doi":"10.1016/j.jvsvi.2025.100216","DOIUrl":"10.1016/j.jvsvi.2025.100216","url":null,"abstract":"<div><h3>Background</h3><div>The adoption of minimally invasive techniques for treating chronic venous insufficiency has surged. Techniques such as foam sclerotherapy and radiofrequency ablation (RFA) are now widely used to address incompetent great saphenous veins. Duplex ultrasound examination has become the gold standard for diagnosing venous insufficiency and evaluating the effectiveness of these treatments. However, venous reflux ultrasound studies remain some of the most time-consuming tasks to obtain.</div></div><div><h3>Objective</h3><div>The objective of this study was to evaluate the effectiveness of minimally invasive vascular interventions, such as foam sclerotherapy and/or RFA, using mobile multispectral near-infrared spectroscopic (NIRS) imaging. By measuring changes in tissue oxygenation (StO<sub>2</sub>) before and after treatment, this study aims to provide insights into the utility of NIRS imaging as a noninvasive tool for assessing treatment outcomes.</div></div><div><h3>Methods</h3><div>This quasi-experimental pre-post-test design study included 14 patients treated for chronic venous insufficiency with either foam sclerotherapy or RFA between November 2022 and February 2024. The patient population presented with significant great saphenous vein insufficiency and normal deep venous pathology, with no evidence of deep vein thrombosis or superficial vein thrombosis, except for one case with partial chronic and deep venous thrombosis. NIRS images of the lower extremities were collected before and immediately after the treatment. The images were acquired from various anatomical locations including the dorsum and plantar aspects of the foot, the medial and lateral leg, and the wound area if present.</div></div><div><h3>Results</h3><div>The results demonstrated a statistically significant increase in mean StO<sub>2</sub> in lower extremities after foam sclerotherapy and RFA, indicating an improved microcirculatory function in the treated limb. These improvements in StO<sub>2</sub> in the lower extremities were consistent with the vascular examination results, which confirmed successful vein ablation or closure.</div></div><div><h3>Conclusions</h3><div>The study demonstrates that NIRS imaging effectively tracks treatment-related changes, providing a noninvasive and reliable method for the real-time assessment of StO<sub>2</sub>. By visualizing changes in microcirculation, this technology offers clinicians valuable insights, enabling earlier detection of treatment success or failure and facilitating timely interventions. As such, NIRS imaging holds promise as a valuable tool in clinical practice for evaluating the efficacy of minimally invasive vascular treatments. However, the small sample size limits the ability to draw definitive conclusions.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"3 ","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873755","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号