Annals of vascular surgery最新文献

Objectives: This study sought to evaluate technical outcomes of surgery for hemodialysis (HD) versus peritoneal dialysis (PD), and to assess the potential impact of early HD access creation.

Methods: Retrospective review was conducted of all adult patients undergoing PD catheter placement or arterial-venous fistula/graft creation for initial dialysis access at a single center, 1/2018 - 8/2023. Outcomes were assessed for patients undergoing PD versus HD, along with the association between time to first use of an AV fistula/graft and time to failure.

Results: During the study period 271 patients underwent creation of an AV fistula/graft with 229 (85%) initiating HD, of which 180 (79%) successfully utilized their fistula/graft. A total of 76 patients underwent placement of a PD catheter with 74 (97%) initiating PD, of which 70 (95%) successfully utilized their PD catheter. Median time from initial surgery to first successful use of dialysis access was 92 days for AV fistulas/grafts, versus 25 days for PD catheters (p<0.001). Among patients who successfully accessed their AV fistula/graft or PD catheter, a significant difference was observed in rates of reintervention (HD 70% versus PD 44%, p<0.001). Median time from initial surgery to reintervention was 166 days for AV fistulas/grafts, compared to 331 days for PD catheters (p=0.026). No association was observed between time from fistula/graft creation to first use and time from first use to failure (p = 0.84).

Conclusions: Significant differences in technical outcomes exist between HD and PD, while early creation of HD access may not be associated with length of usable access life.

Introduction: The C-C chemokine receptor 2 (CCR2) drives macrophage recruitment in the abdominal aortic aneurysm (AAA) wall, and α_vβ₃ integrin plays a key role in angiogenesis at the aneurysm site. We aimed to evaluate the expression of CCR2 and α_vβ₃ integrin in patients with AAA utilizing single-photon emission computed tomography (SPECT) with the novel radiotracers technetium-99m 6-hydrazinylnicotinoyl-C-C-chemokine receptor-2 ligand (^99mTc-HYNIC-CCR2-L) and technetium-99m arginine-glycine-aspartic acid (^99mTc-RGD).

Methods: This in vivo pilot study included patients with atherosclerotic, asymptomatic, small AAA and a history of smoking. Patients were then allocated to one of two groups to analyze inflammation (^99mTc-HYNIC-CCR2-L) or angiogenesis (^99mTc-RGD). Radiotracer uptake with SPECT was based on the region of interest (ROI), expressed as counts per minute (cpm). We quantified inflammation and angiogenesis at aneurysmal and non-diseased/control aorta, and evaluated with the Wilcoxon signed rank and t-tests using GraphPad Prism software, version 9.0 (GraphPad Software Inc., Boston, MA, United States).

Results: A total of 9 patients (77% males, mean age of 78 ±8 years) were studied. In the inflammation group (n=5), the ROI mean value of the aneurysm site was 44,442 cpm (standard error [SE]: 10,309 cpm; median 33834 and range: 26,950-81,910 cpm), which was higher than that of the non-diseased aorta (mean ROI: 24,633 cpm; SE: 2,141 cpm; median 14775 and range: 10,514-68,700 cpm) (p=0.01). In the angiogenesis group (n=4), we visualized a higher ^99mTc-RGD uptake at the aneurysm site (mean ROI: 7,471 cpm; SE: 224 cpm; range: 7,042-8,102 cpm) compared to the control aorta (mean ROI: 7,347 cpm; SE: 238 cpm; range: 6,901-8,002 cpm) (p=0.0001).

Conclusion: We detected increased inflammatory and angiogenic activity at the AAA site compared to the non-diseased aorta, as determined by SPECT. Further research with molecular imaging should address the pathophysiology of aneurysmal progression and rupture.

Introduction/objectives: Patients undergoing surgical procedures for peripheral artery disease and carotid artery stenosis are recommended to undergo surveillance imaging at regular intervals. With > 250,000 patients undergoing interventions for both annually, the number of patients requiring interval surveillance increases in parallel, placing strain on an already overburdened health system. In this study we evaluated the performance of a novel ultrasound platform prototype built for remote ultrasound surveillance.

Methods: The prototype duplex ultrasound device was developed by a team of engineers and utilizes color flow images to detect the vessel for flow velocity measurements. The device was tested on 28 healthy volunteers. The results of spectral flow from the device were compared to standard of care ultrasound measurements of the CFA, SFA, ICA and CCA.

Results: The mean absolute difference between the prototype ultrasound and standard of care device for peak systolic velocity of the CFA, SFA, CCA, and ICA were 3.06 cm/s, 2.27 cm/s, 3.51 cm/s, and 3.55 cm/s, respectively. There were no significant differences between measurements recorded by the prototype and the standard of care device.

Conclusion: It is feasible to make a small, wearable ultrasound device that can collect accurate waveform and flow velocity data from healthy volunteers. Such a device has the potential to expand access to vascular imaging to low resource regions and improve the surveillance of patients after vascular surgery procedures.

Introduction: Peripheral artery disease (PAD) is frequently associated with peripheral neuropathy and is often compounded by comorbidities such as diabetes. PAD significantly increases the risk of lower extremity amputation, particularly below-knee amputation (BKA), which may severely impair patients' mobility. Although recent surgical advances, such as targeted muscle reinnervation (TMR), have improved outcomes in pain and neuroma formation, patients with PAD who undergo BKA with TMR may still face some functional challenges. Therefore, this study aimed to investigate the impact of PAD in patients undergoing BKA with TMR on their lower extremity function.

Methods: A single-center study was conducted from June 2021 to July 2024. Adult patients who could safely ambulate without open wounds or lower extremity surgery within 90 days were included. PAD status and BKA with TMR history were documented through a retrospective chart review. Participants completed 120-second walk and 30-second Romberg sway tests with wearable sensors. Gait data were collected through Motility lab software, speed (m/s), elevation mid-swing (cm), step duration (s), cadence (steps/min), single limb support (%), double limb support (%), and stride length (m) were averaged using both lower extremities' data. Root-mean-square (RMS) sway (m/s2), indicative of sway area posture stability, was also extrapolated. Cohen's D and power analysis were completed for effect size determination.

Results: Eighteen patients with unilateral BKA with TMR were identified; ten (55.6%) of the 18 patients had PAD. Patient characteristics, including age, BMI, and CCI, were comparable between groups (Table 1). Average gait speed (0.89 ± 0.08 vs 0.58 ± 0.28, p=0.01), single limb support (35.91 ± 1.50 vs 31.68 ± 3.37, p=0.01), double limb support (28.13 ± 2.99 vs 36.71 ± 6.99, p=0.01), and stride length (0.85 ± 0.08 vs 0.71 ± 0.11, p=0.01) were significantly different between Non- PAD and PAD groups, respectively. There were no differences seen in elevation at mid-swing, step duration, cadence, or RMS sway (Table 2).

Conclusion: Patients with PAD undergoing BKA with TMR experience significantly impaired gait function compared to non-PAD patients. These findings highlight the need for tailored rehabilitation strategies to address this population's mobility challenges.

Introduction: Thoracic Outlet Syndrome (TOS), although rarer in children, can significantly impact quality of life. While surgical management in the adult population is well reported, data on transaxillary first rib resection (TFRR) in the pediatric population is scarce. We aimed to assess the outcomes of TFRR in pediatric patients with TOS.

Methods: A retrospective review was performed on all patients aged 18 or younger who underwent TFRR for symptomatic TOS at a single institution between 2012 to 2023. We described the treatment approach and long-term outcomes after TFFR.

Results: TFRR was performed in 91 patients (median age 17 years [range 12-18 years], 66.7% female, 85.3% Caucasian), including 42 neurogenic (nTOS), 51 venous (vTOS), 3 arterial (aTOS), and 6 mixed TOS. The median symptom duration was 735 days for nTOS and 52 days for vTOS. After a median follow-up of 13 months, 97.6% of nTOS patients reported symptomatic improvement and 55.2% of athletes returned to sports. In patients with vTOS, 86.0% demonstrated patent axillo-subclavian veins, 98.0% reported symptomatic improvement, and 72.7% of patients resumed athletic activities at last follow-up. For aTOS, all three patients experienced symptomatic improvement, with no arterial reconstruction required. In mixed TOS cases, patients similarly demonstrated favorable outcomes, including symptomatic improvement and vein patency. No major complications were observed in this series.

Conclusion: In this case series, we demonstrated that TFRR confers a benefit to patients with TOS in the pediatric age group, regardless of TOS type, with high rates of symptomatic improvement, return to sports, and minimal complications.

Background: Lower extremity vascular trauma could end in sequelae or death if inadequately managed. The majority of data comes from large databases with high heterogeneity among centers. This study reports the experience of a single urban referral center with a structured approach to vascular trauma.

Methods: Retrospective descriptive-analytical review of the trauma registry of a trauma center between 2018 and 2024. Patients with arterial or venous injuries who underwent intervention were included. Demographic, clinical, surgical and trauma mechanism were described. The primary outcome was major amputation rate at 30-D, secondary outcomes were 30-D mortality, postoperative revascularization thrombosis (PRT) and complications.

Results: 89 patients, median age was 32 years, 92.1% were male and 70.8% were penetrating traumas. Isolated arterial injuries accounted for 43.8%, isolated venous for 4.5% and combined for 51.7%. A vascular surgeon was present in 79.8%. Most frequently compromised arteries were the superficial femoral (37.6%), popliteal (34.1%) and tibial vessel (21.2%). Secondary major amputations at 30-D occurred in 7.1% of arterial lesions more frequent in popliteal trauma (p = 0.04). 30-D mortality was 3.3%. PRT (OR 7.5, p = 0.021), orthopedic injury (OR 16.9, p = 0.006) and significant soft tissue injury (OR 8.44, p = 0.01) were significant risk factors for secondary major amputation. The presence of a vascular surgeon was protective for PRT (OR 0.06, p = 0.001).

Discussion: amputation rates were lower than the previously reported. Factors that may influence these outcomes are the follow of an institutional protocol and the presence of a vascular surgeon; poor outcomes were associated with soft tissue compromise, orthopedic injury, blunt trauma and PRT.

Endovascular technology for aortic aneurysm repair has undergone significant evolution. Vascular surgeons have worked to expand its applicability to para-visceral and thoracoabdominal aortic aneurysms. Physician-modified endografts (PMEGs) are increasing in popularity for treating complex aneurysms, particularly in patients unfit for open surgical repair. Current data indicate that short-term morbidity and mortality after PMEGs are independent of the hospital case volume. However, further studies are necessary to clarify postoperative endoleaks and longer-term consequences. From a medico-legal and financial perspective, high-volume centers have the advantage of establishing a sustainable PMEG program.

Introduction: Industry partnerships represent an important aspect of vascular surgery, providing opportunities for professional growth, research, and innovation. It is well established that women surgeons earn less than their male counterparts at all specialties and ranks. This study sought to investigate whether these gender payment disparities carried into vascular surgery industry partnerships.

Methods: A retrospective study was performed analyzing the Centers for Medicare and Medicaid Open Payments Database, from which all general and research payment data from 2016-2022 was collected. Gender was assigned based on the US NPI Registry. Total annual payment per surgeon for each year was calculated and compared between men and women vascular surgeons. Each year's per surgeon total was then averaged to provide the average annual payment per surgeon, across the seven years of data, and similarly compared between genders. The same analysis was then conducted for the top 10% of women earners compared to the top 10% of men earners. NPI enumeration date was then used to calculate years of experience for each surgeon and used to stratify data to normalize for surgeon experience. Median data was analyzed via Wilcoxon rank-sum testing due to non-normal distributions.

Results: From 2016 to 2022 456,931 payments were made to 5,839 vascular surgeons, of which 901 (15.4%) were female and 4,938 (84.6%) males. On yearly analysis, median total annual payments made to male surgeons were 1.2-1.7x higher than female surgeons (p<0.05 for all years except 2021) (median average annual payment: $478.97 vs $545.30, p<0.001). Among the top 10% of earners in each gender, males made 2.2-3.9x more than females on yearly analysis (p<0.05 for all years) ($12,008.04 vs $27,052.71, p<0.001). When stratified for experience, there was no significant difference between genders for those with less than 7 years of experience (residency and fellowship trainees). However, female surgeons earned significantly less in the 7-11.5 year cohort ($506.29 vs $713.11, p=0.01) and in the 11.5-16 year cohort ($732.09 vs $895.01, p=0.02). There was no significant difference in the >16 year cohort.

Conclusion: These data demonstrate that women vascular surgeons receive less industry payment than men, with a larger pay gap among the top 10% of earners. Disparities remain even after adjusting for experience, although less so among the most senior surgeons.

Objective: To report the technical considerations and long-term outcomes of resection and vascular reconstruction of primary leiomyosarcoma (LMS) of the inferior vena cava (IVC).

Methods: A single-center retrospective review of patients undergoing surgical resection for primary IVC LMS between 2012-2024. Patient demographics, operative details, and long-term outcomes were analyzed.

Results: Nine patients (5 females, median age of 59 years (IQR 50-71)) underwent resection. Median tumor size was 86 mm (IQR 83-170); with 78% (n=7) located at the renocaval junction. The median length of IVC resected was 75 mm (IQR 28-108). All patients with circumferential resection underwent reconstruction with ringed PTFE graft (n=7, 78%), with contralateral renal vein re-implantation in 4 (44.4%). Two patients had partial resections with lateral IVC venorrhaphy in one and bovine patch venoplasty in the other two. Intraoperative ultrasonography was used in all cases to define extent of resection; preoperative venography with intravascular ultrasound (IVUS) performed in 2 patients to assess IVC patency, tumor extent, and renal vein involvement. Midline incision was used in 6 and Chevron incision in 3 more cephalad lesions. Major adverse events occurred in 4 patients (44%), but no 30-day mortality was observed. Median hospital stay was 6 days (IQR 5-11). Over a median follow-up of 26 months (IQR 9-80), primary graft patency was 100%. Recurrence occurred in 4 patients (44%) at a median of 34 months from surgery. Adjuvant chemotherapy was given to 3 patients and radiation to 1. Overall survival at 3 and 5 years was 89% and 78%, respectively CONCLUSIONS: Complete resection of IVC LMS with vascular reconstruction offers favorable long-term outcomes. Preoperative venography in selected patients, and intraoperative ultrasound in all patients should be considered.

Background: Lower limb peripheral artery disease (PAD) is a prevalent, debilitating vascular condition associated with high morbidity, mortality, and healthcare costs. Despite established pharmacological, lifestyle, and interventional therapies, suboptimal adherence limits its effective management. Digital therapeutics (DTx) have emerged as innovative tools able to support patients in the management of their disease. Our objective was to identify the key elements for developing a DTx to prevent poor outcomes in PAD in France.

Methods: A structured review was performed using PESTEL (Political, Economic, Sociocultural, Technological, Environmental, Legal) and SWOT/TOWS (Strengths, Weaknesses, Opportunities, Threats) frameworks. This review evaluated macro-environmental drivers, systemic constraints, and implementation opportunities.

Results: The PESTEL analysis highlighted major challenges: limited preventive strategies, underdeveloped ambulatory care, shortages of healthcare professionals, complex reimbursement processes, and significant economic and environmental burdens. Opportunities included supportive policy initiatives for DTx, technological readiness for telemonitoring, and growing public interest in accessible digital solutions. The SWOT/TOWS analysis identified DTx as strategically positioned to improve adherence, facilitate outpatient pathways, reduce administrative workload, and mitigate workforce constraints. Key design features identified patient education, behavioral nudges, multimodal data inputs, and nurse-led follow-up.

Conclusions: PESTEL and SWOT/TOWS analyses provide a structured, context-specific framework for developing a PAD-focused DTx. The tool should improve adherence, reduce hospitalizations, and align with public health goals of prevention, efficiency, and sustainability. Further clinical evaluation is needed to confirm real-world value. This approach may also serve as a model for PAD-focused DTx in other countries or DTX targeting other chronic cardiovascular diseases.