Annals of vascular diseases最新文献

Objectives: Hypertension is a metabolic disorder affecting a significant proportion of the global population. Growing evidence suggests the contribution of gut microbiota to blood pressure homeostasis and the effectiveness of antihypertensive interventions. This systematic review evaluates the role of gut microbiota in hypertension and identifies microbial taxa contributing to or alleviating the condition.

Methods: A systematic search was conducted in PubMed and Cochrane databases for non-randomized studies, randomized controlled trials, and registry studies published in English. Studies were classified according to microbial taxa involved in the improvement or worsening of hypertension.

Results: According to the inclusion criteria, 19 studies were included. Some bacterial genera, such as Lactobacillus paracasei, Akkermansia, and Veillonella, had potential protective effects against hypertension by regulating blood pressure through dietary interactions and microbial metabolites. On the other hand, Klebsiella sp., Streptococcus sp., and Parabacteroides merdae were more abundant in hypertensive patients and were involved in dysbiosis and inflammation. The fungal taxa Malassezia and Mortierella were also involved in the pathogenesis of hypertension.

Conclusions: Gut microbiota composition may play crucial roles in hypertension, with certain taxa potentially contributing to or alleviating the condition. Modulating gut microbes through probiotics and diet may offer new therapeutic approaches.

An 84-year-old woman with an acute type B aortic dissection (ATBAD), an entry tear in a distal arch aneurysm, and lower-body malperfusion underwent a hybrid approach combining total arch replacement with an elephant trunk (TAR+ET), thoracic endovascular aortic repair (TEVAR), and left renal artery stenting. This strategy avoided direct resection of the aneurysm or primary entry, yet stabilized hemodynamics and restored organ perfusion. Postoperative CT was favorable, and the patient was discharged without complications. In this elderly case of complicated ATBAD involving a distal aortic arch aneurysm, we performed TAR+ET, TEVAR, and renal artery stenting, and achieved a favorable outcome.

True aneurysms of the digital artery are extremely rare, and only several dozen cases have been reported worldwide. A 29-year-old man presented with a pulsatile, tender nodule in his left index finger. Angiography revealed a 7-mm saccular aneurysm of the proper palmar digital artery with well-developed distal collaterals. Under local anesthesia, the aneurysm was excised following proximal and distal ligation. It was histopathologically confirmed as a true aneurysm. Postoperatively, symptoms resolved without ischemic or neurological complications and without recurrence after 1 year. Thus, simple ligation and excision are effective when collateral circulation is sufficient.

A 79-year-old man was admitted for transurethral resection of a bladder cancer. He had a history of thoracic endovascular aortic repair for Stanford type B acute aortic dissection and thoracic aortic aneurysm performed 2 years prior. During hospitalization, computed tomography scan findings raised suspicion of a stent-graft infection. Blood cultures confirmed the presence of Streptococcus gallolyticus ssp. pasteurianus. Gallium scintigraphy supported the diagnosis of a stent-graft infection. A subsequent lower gastrointestinal endoscopy revealed a colorectal cancer in the lower rectum. We then performed surgery for the stent-graft infection.

Objectives: The objective of this research was to examine the occurrence, clinical features, treatment approaches, and results associated with a rare complication of thrombosis of the popliteal artery after total knee arthroplasty (TKA), leading to acute limb ischemia (ALI). Methods: A retrospective study on 1020 TKA procedures spanning 5 years. Cases of ALI were identified through clinical evaluation and arterial Doppler studies. Peripheral angioplasty was done to recanalize the popliteal artery. Manifestations, complications, and management strategies were evaluated. Results: Among the 1020 TKA cases, 5 cases of ALI were identified which accounts for 0.49% of all TKA cases. Female predominance and left-sided presentations are notable observations. Most patients presented within 8 hours of symptom onset with diverse complications ranging from foot drop to compartment syndrome. Except for 1 case, all patients recovered with thrombosuction and balloon dilatation. Conclusions: A rare but potentially fatal complication of TKA is popliteal artery thrombosis leading to ALI so it becomes important for early recognition and intervention to mitigate the adverse outcomes. In our study, endovascular treatment has emerged as the preferred modality in terms of effective management and reducing complications and morbidity from surgical procedures.

We report a case of a 68-year-old female patient with an 8-mm right gastric artery aneurysm. The attempt at endovascular treatment was unsuccessful and therefore the patient underwent laparoscopic surgery for the resection of the unruptured right gastric artery aneurysm. The postoperative course was uneventful, and the patient is currently under observation as an outpatient. Although endovascular treatment is the first choice for treatment of unruptured right gastric aneurysms, laparoscopic surgery offers advantages such as less invasiveness, anatomical accessibility, and the ability to perform histopathological examination, making it an effective treatment option when endovascular treatment is difficult.

Objectives: We primarily aimed to compare the acute effects of hand-squeezing exercises, with and without tourniquet-like compression, on vessel size 5 minutes post-exercise in patients after arteriovenous fistula (AVF) creation. The secondary aim was to assess differences in AVF blood flow rates between the 2 interventions. Methods: A randomized study was conducted at a university hospital in Bangkok, Thailand, from October 2018 to September 2023. Seventy-eight participants, 2 weeks post-first-time autogenous AVF creation, were randomized into 2 groups: a non-compression group (n = 39) performing 5 minutes of hand-squeezing exercises and a compression group (n = 39) performing the same exercises with tourniquet-like compression. Ultrasound measured venous diameter and blood flow rates pre- and post-exercise. Results: Both groups showed increased venous diameter, but the difference between the groups was not statistically significant (mean difference: 0.18 mm with compression vs. 0.12 mm without; P = 0.489). Blood flow rates increased significantly in the compression group compared to the non-compression group (mean difference: 171.49 vs. 24.44 mL/min; P = 0.002). Conclusion: Hand-squeezing exercises with tourniquet-like compression significantly improved AVF blood flow rates acutely, supporting its potential to enhance AVF maturation. Further research is needed to assess long-term benefits.

The underlying mechanisms of abdominal aortic aneurysms (AAAs) are not fully understood. Given the multifactorial nature of AAA development and progression, a comprehensive approach is essential. Throughout my academic career, I conducted various studies on AAA. To better understand this mechanism, I initially developed an elastase-infused rat AAA model and applied it to nanoparticle drug delivery systems. While open surgery has traditionally been the standard treatment for AAA, endovascular aneurysm repair (EVAR) has seen significant advancements over the past 25 years. However, insufficient evidence exists regarding this novel treatment, particularly in Japan. To address this issue, we analyzed extensive datasets on EVAR using various registries, including the Japanese Committee for Stent Graft Management. Furthermore, through medical-engineering collaboration, simulation methods were utilized to generate evidence addressing clinical questions encountered in practice.

Late postoperative type 3 endoleaks associated with the AFX (Endologix, Irvine, CA, USA) stent-graft are commonly reported. The AFX's endoskeletal design raises concerns about wire entrapment between its frame and fabric, as well as a risk of type 1a endoleak. An 84-year-old man with prior EVAR using the AFX presented with a type 3b endoleak 4 years postoperatively. He underwent relining with the TREO stent-graft (Terumo Aortic, Sunrise, FL, USA), which enabled easy contralateral gate cannulation and secured a long proximal landing zone. The TREO appears to be a viable option for relining the AFX in type 3b endoleak cases.

Objectives: Thoracic endovascular aneurysm repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms (TAA) by providing a less invasive alternative to open surgery. This study aims to identify risk factors for early mortality following TEVAR for degenerative TAA using a machine learning-based decision tree analysis (DTA). Methods: This retrospective observational study analyzed 79 patients who underwent elective TEVAR to identify predictors of early mortality (within 2 years) using decision tree analysis. The dataset included 36 variables, covering age, sex, nutritional status, comorbidities, inflammation, immune status, and surgical details. The decision tree classifier was developed and validated using Python 3.7 with the scikit-learn toolkit. Results: DTA identified octogenarian status as the strongest predictor of early mortality, followed by poor nutritional status, debranching procedures, and compromised immunity. The model identified 7 terminal nodes, with early mortality risk ranging from 0% to 77.7%. It demonstrated moderate accuracy (65.8%) and high sensitivity (81.0%) but had relatively low specificity (60.3%), effectively identifying high-risk patients. Conclusions: Machine learning-based DTA identified key predictors of early mortality following TEVAR, including octogenarian status, poor nutritional status, compromised immunity, and debranching procedures. The model provides an interpretable risk stratification tool, but its clinical applicability requires further validation.