Annals of vascular diseases最新文献

Artificial intelligence (AI) and machine learning (ML) are transforming vascular surgery by enabling precise risk stratification, individualized treatment planning, and improved prognostic prediction. In abdominal aortic aneurysm (AAA) management, ML algorithms integrate complex clinical and imaging data to estimate survival, guide procedural decisions, and identify key factors influencing aneurysm remodeling. These models outperform traditional statistical approaches by capturing nonlinear interactions among variables such as nutritional status, immune function, and anatomical features. Despite these advances, challenges remain. Many studies rely on single-center datasets, raising concerns about overfitting and limited generalizability. The use of black-box models can hinder clinical trust due to limited interpretability. However, recent developments in multicenter data collection and explainable AI techniques are improving model robustness and transparency. As these tools continue to evolve, ML is poised to contribute meaningfully to precision vascular care. By supporting more individualized and data-informed decision-making, ML has the potential to enhance long-term outcomes and guide the future of AAA management after endovascular aneurysm repair.

Percutaneous transluminal renal angioplasty (PTRA) is a treatment for renovascular hypertension due to renal artery stenosis. However, postoperative complications in stent re-stenosis/occlusion may occur frequently. A 60-year-old male patient presented to our hospital with uncontrolled hypertension and a deterioration of renal function. He had undergone an initial renal stenting 10 years earlier, followed by repeat PTRAs during follow-up for in-stent restenosis. The left renal stent was found to be completely occluded, while the right renal stent was found to be 75% stenosed. We performed an aorto-renal artery bypass. The bypass was patent without stenosis and the renovascular hypertension was recovered.

Chronic expanding hematoma (CEH) is a rare late complication of thoracic trauma or surgery, and favorable outcomes with transcatheter arterial embolization (TAE) have rarely been reported. An 80-year-old male presented with recurrent hemoptysis and was diagnosed with intrathoracic CEH. Owing to advanced age and high surgical risk, TAE was performed via bronchial, intercostal, and inferior phrenic arteries using tris-acryl microspheres (700-900 μm) and gelatin sponge. Hemoptysis resolved, and follow-up imaging showed hematoma shrinkage without recurrence for 2 years. This case demonstrates TAE with 700-900 μm microspheres as a safe, minimally invasive alternative to surgery for CEH.

Objectives: Familial hypercholesterolemia (FH) accelerates systemic atherosclerosis and worsens prognosis from youth. While present in 5%-10% of premature coronary artery disease (pCAD) cases, its prevalence and impact in lower extremity artery disease (LEAD) remain unclear. This study investigated FH prevalence and prognostic impact in premature LEAD (pLEAD).

Methods: We retrospectively analyzed LEAD patients aged ≤70 years undergoing first revascularization. FH was diagnosed according to the 2022 Japan Atherosclerosis Society Guidelines, based on dyslipidemia and Achilles tendon thickness. Primary outcomes were survival, amputation-free rate, and secondary intervention-free rate.

Results: Among 66 pLEAD patients (median age 66 years, 76% male), 10 (15%) met the FH criteria. Compared with non-FH patients, FH patients more frequently presented with chronic limb-threatening ischemia (CLTI) (90% vs. 36%, p = 0.001), bilateral lesions (100% vs. 36%, p <0.001), and dialysis dependence (90% vs. 25%, p <0.001). Three-year survival (28% vs. 90%, p <0.001), amputation-free rate (64% vs. 89%, p = 0.028), and secondary intervention-free rate (38% vs. 63%, p = 0.031) were significantly lower in FH patients. In the CLTI subgroup, survival was markedly reduced in FH (17% vs. 71%, p = 0.011).

Conclusions: FH was present in 15% of pLEAD patients and associated with poor outcomes. Routine FH screening, including pCAD history and Achilles tendon evaluation, may improve prognosis.

Tracheoinnominate artery fistula is a rare but potentially fatal complication of tracheostomy. We report the case of a 22-year-old male at high risk for tracheoinnominate artery fistula due to severe thoracic deformity. To mitigate the risk, a prophylactic transection of the innominate artery was successfully performed using a combined suprasternal and intercostal approach, thereby avoiding limb perfusion. The patient was discharged without complications. This case highlights the effectiveness of the combined approach for safe innominate artery transection in anatomically challenging cases.

Objectives: The purpose of this study was to evaluate the results of endovascular therapy (EVT) with common femoral artery (CFA) endarterectomy site access for lower extremity artery disease (LEAD).

Methods: Records were reviewed retrospectively for patients who underwent EVT with CFA endarterectomy site access from 2014 to 2023 at 7 hospitals.

Results: A total of 74 EVT procedures with CFA endarterectomy site access were performed in 65 patients with LEAD. The median [interquartile range] interval between CFA endarterectomy and the first EVT access was 435 [237-1153] days. Technical success of EVT was achieved in 72 procedures (97%). Technical success of the puncture was achieved in all 74 procedures (100%). The median [interquartile range] puncture time and hemostasis time were 4 [2-6] and 13 [10-20] min, respectively. Two cases (3%) had access site hematoma, which was cured with conservative treatment.

Conclusions: The CFA after endarterectomy may be a safe and suitable access site for EVT.

In Japan, the absence of commercially available fenestrated and/or branched endografts has necessitated widespread adoption of physician-modified endografts (PMEGs) for complex aortic aneurysms. This paper compares PMEG use in Western countries and Japan, summarizes multicenter outcome data, and highlights the gap between real-world practice and current Japanese aortic disease guidelines. Recent Japanese series report high technical success and acceptable mid-term outcomes, comparable to Western reports. While long-term durability remains uncertain, structured training, national registries, and standardized protocols are essential. Guideline acknowledgment of PMEGs could improve safety, consistency, and international alignment in complex endovascular therapy. Establishing structured training, national registries, and evidence-based policy recognition of PMEGs is essential to ensure safe and standardized practice in Japan.

A 62-year-old male with empyema underwent an attempted pleural drainage, which resulted in iatrogenic pseudoaneurysm formation of the right pulmonary artery in the interlobar segment. Endovascular treatment was favored over surgical intervention due to the presence of empyema. The pulmonary artery in the interlobar segment was embolized with metallic coils, with inevitable occlusion of blood perfusion in the middle and lower lobes. Despite the perfusion loss in a large lung territory, the patient eventually required no supplemental oxygenation. Coil embolization can be a favorable alternative to stent-grafting for pseudoaneurysm even in the interlobar segment, despite the potential risk of post-procedure hypoxemia.

Objectives: Femoral endarterectomy often requires patch angioplasty, and saphenous vein patch (SVP) was the standard. However, bovine pericardial patch (BPP) provides potential advantages, including no requirement for vein harvest, use of the access site for concomitant endovascular procedures, and favorable handling characteristics. We compared the short- and mid-term outcomes of BPP and SVP in femoral endarterectomy.

Methods: This retrospective, single-center study included 42 patients (49 limbs) who underwent elective femoral endarterectomy with patch closure between September 2016 and January 2025. The patients were grouped by patch type as follows: 28 limbs with BPP and 21 limbs with SVP. Primary endpoints included patency and freedom from target lesion revascularization at the endarterectomy site. Secondary endpoints included perioperative complications, limb salvage, and intraoperative arterial clamp time.

Results: No patch-site restenosis or re-intervention occurred in either group. There were no patch infections, and the perioperative complications were similar. Limb salvage at 40 months was 87.5% with BPP vs. 95.0% with SVP (p = 0.42). Intraoperative arterial clamp time was significantly shorter in the BPP group (55.0 vs. 69.5 min, p = 0.01).

Conclusions: BPP represents a safe and valuable alternative option for femoral endarterectomy.

An 81-year-old female with bilateral small saphenous vein varicosities (CEAP, C2s, Ep, As, Pr) underwent cyanoacrylate closure (CAC) and stab avulsion under general anesthesia. Fourteen days later, she developed severe dyspnea and was diagnosed with pulmonary embolism (PE) and deep vein thrombosis. Despite anticoagulation, cardiopulmonary support, and catheter-directed thrombectomy, she died 24 days after admission. Adequate heparin dosing with activated partial thromboplastin time monitoring is important. Prolonged procedures under general anesthesia may increase PE risk. Early ambulation, compression therapy, and follow-up ultrasonography beyond 24 hours may help detect delayed thrombus formation and reduce life-threatening complications after CAC.