Annals of vascular surgery最新文献

Objectives: Arterial aneurysms at various anatomical locations are known to be associated with one another. Prior research has suggested that abdominal aortic aneurysms (AAA) occur more often in patients with intracranial aneurysms (IA) compared to the general population. Unfortunately, the current body of literature on this subject is scarce.The primary objective of this study was to evaluate the risk of concomitant AAA among patients with IA.

Methods: This was a retrospective cohort study conducted at two collaborating neurovascular centres. Each centre identified IA patients (either ruptured or unruptured). Patients were included if imaging which could detect an AAA was performed at any point in time. The primary outcome was the occurrence rate of AAA in the study population. The secondary objective was to identify potential risk factors for concomitant AAA in IA patients.

Results: 3.609 IA patients were screened of whom 1.182 underwent imaging of the abdominal aorta. After exclusion based on several criteria, 1.070 IA patients were included. Within this study cohort, an occurrence of 79 AAAs was found (7.4%). Male sex and increasing age were risk factors for the occurrence of an AAA.

Discussion and conclusion: Imaging in this study revealed an AAA occurrence rate of 7.4% in the included IA patients, which is substantially higher than the prevalence of the general population and the known prevalence in male individuals over 60 years. Additional risk factors include male sex and advanced age. These findings support consideration of screening for AAA in patients diagnosed with IA.

Thoracic outlet syndrome is a disabling condition in which surgical treatment is considered for patients after failure of physical therapy or in the presence of vascular complications. The aim of this study was to evaluate the outcomes of first rib resection via the transaxillary approach using patient-reported outcomes measures with QuickDASH and SF-36, and to identify potential predictors of surgical success. We conducted a single-center prospective study over one year. All patients undergoing surgery for thoracic outlet syndrome were asked to complete QuickDASH and SF-36 questionnaires preoperatively and at last follow-up. 88 patients were included, with a mean age of 38.5 +/- 10 years; 65 (73.8%) were women. All patients underwent first rib resection via the transaxillary approach, associated with pectoralis minor section in 46 cases (52.2%). The mean duration of follow-up was 92.2 +/- 56 days postoperatively. The mean preoperative QuickDASH score was 61 +/- 1.8 which improved significantly to 44.3 +/- 2.04 postoperatively (p<0.05). Significant improvement was reported in all SF-36 domains except for physical functioning. On multivariate analysis, female sex was identified as an independent predictor factor of favorable surgical outcomes (RR 1.6291 (IC95% 1.00-2.63) p=0.046). At 3-months follow-up, transaxillary first ribs resection results in functional improvement in patients with thoracic outlet syndrome, with female sex identified as an independent predictor of better outcomes.

Objective: In the study, we aimed to analyze the early and mid-term outcomes of treating abdominal aorto-iliac aneurysms (AIAs) with endovascular repair in our center.

Methods: This was a retrospective review of patients undergoing endovascular repair for AIAs from January 2020 to January 2024. Primary outcomes were mortality and technical success. Secondary outcomes included major complications, stent patency, re-intervention, incidence of endoleak, and freedom from pelvic ischemia.

Results: A total of 67 abdominal aortic aneurysms and 127 iliac artery aneurysms were treated in 67 patients (mean age, 75.3 years; 79.1% men). Unilateral internal iliac artery (IIA) embolization and coverage + contralateral IIA preservation were the main methods in 59 cases (88.1%), leaving 8 cases (11.9%) of bilateral IIAs preservation. Technical success was 98.5% (66/67). 6 patients (10.2%) developed buttock claudication in unilateral IIAs occlusion. There were 3 cases (4.5%) of early re-intervention and 8 cases (11.9%) of major complications. The median follow-up duration was 19.0 months (range,1-53 months). Survival rates at 30 days, 12 months, and 36 months were 98.5%±1.5%, 98.5±1.5%, and 88.4±5.0%, respectively. One aneurysm-related death (1.5%) occurred at 17 months postoperatively. Estimates up to 36 months, the cumulative primary patency rate was 95.5%±2.6% and the cumulative primary-assisted and secondary patency rate was 100%. 4 patients (6.0%) underwent unplanned late re-intervention, 13 cases (18.6%) had endoleaks during the follow-up.

Conclusion: The early and mid-term results of endovascular repair for treating AIAs were favorable, and preserving at least one IIA was recommended.

Objective: To evaluate the utility of carbon dioxide (CO₂) angiography in the detection of type II endoleak during endovascular treatment of infrarenal abdominal aortic aneurysms.

Methods: A retrospective analysis was conducted on a prospectively enrolled 20 consecutive patients with infrarenal abdominal aortic aneurysms treated with endovascular aneurysm repair (EVAR) and intraoperative completion imaging using both contrast media and CO2. The primary endpoints were the early intraoperative detection of type II endoleak, and 30-day reintervention and mortality. The secondary endpoints were the confirmatory diagnosis of type II endoleak on the first postoperative and follow-up CT scans, follow-up reinterventions, follow-up mortality, and safety of CO₂ angiography.

Results: Twenty male patients (median age 71 years) were included. Intraoperative CO₂ angiography identified a higher detection rate of type II endoleak in 9 patients, while iodinated contrast detected type II endoleak in 2 patients (45% vs. 10%, p .189). No type II endoleak was confirmed on the postoperative and follow-up CT scans. No adverse events related to CO₂ angiography were observed. Subgroup analysis revealed patients with CO₂-detected T2EL had larger IMA diameters (3.2 mm vs. 2.3 mm, p=0.030) and more patent lumbar arteries (median 4 vs. 3, p=0.04), while IMA patency and preoperative largest aortic sac diameter were similar. Thirty-day outcomes were recorded as three reinterventions and no mortality. A median follow-up period of 47 months resulted in no newly formed endoleaks, no reinterventions, and one mortality.

Conclusion: CO₂ angiography demonstrated a higher intraoperative detection rate of type II endoleaks during EVAR compared to iodinated contrast. However, none were confirmed on postoperative imaging or led to adverse outcomes during long-term follow-up. These findings suggest that many CO₂-detected type II endoleaks may represent transient, hemodynamically insignificant flow lacking clinical consequence, but may have a future role in evaluating occult or type V endoleaks. Future prospective studies are needed to clarify their clinical relevance.

Introduction: The Alto endograft received CE Mark approval in August 2020 for endovascular repair of abdominal aortic aneurysms (AAAs), requiring a proximal aortic landing zone of only 7 mm below the inferior renal artery for sealing. This study presents early and one-year outcomes from the Hellenic Alto Registry in patients treated for intact AAAs, either electively or urgently for symptomatic aneurysms.

Methods: The Hellenic Registry is a multicenter prospective database including patients who underwent EVAR with the Alto™ Abdominal Stent Graft System between 2021 and 2023. Pre- and postoperative aneurysm characteristics were recorded. Outcomes included early (technical success, 30-day survival) and one-year results (survival, reintervention, sac remodeling, endoleak presence).

Results: 124 patients (96% male, mean age 72.1 ± 6, mean AAA diameter 59.8 ± 10 mm) were included; 94% were asymptomatic. Mean proximal neck diameter at 7 mm was 23 ± 3 mm, length 18 ± 9 mm, and angulation 28 ± 14°. Nineteen patients (15%) had neck length < 10 mm, and fourteen (11%) had an aortic bifurcation < 20 mm. Fifty-eight (45%) had at least one external iliac artery < 7 mm. Technical success was 98%; two patients required intraoperative conversion to an aorto-uni-iliac endograft with femoro-femoral bypass. Six patients underwent limb relining. Mean procedure time was 129 ± 60 min, mean contrast volume was 130 ± 50 mL, and median radiation 27 ± 18 min. Mean hospital stay was 2.5 ± 1.5 days. No intra-operative high flow endoleaks were detected. No death of reintervention was reported at 30 days. The mean aneurysm sac diameter was 58±11mm and 53.6±8mm at 30 days and one post-operative year (58% stable, 34% decreased), respectively. At one-year follow up the survival rate was 99,2% (SE 0,8%), 98,4% (SE 1,1%) and 98,4% (SE 1,1%) at 80, 120 and 365 days respectively; The freedom from reintervention rate was rate was 99,2% (SE 0,8%), 98,4% (SE 1,1%), 96,7% (SE 1,6%) and 95,9% (SE 1,8%) at 30, 60, 180 and 365 days respectively. Freedom from type I endoleak rate was 99,2% (0,8%), 98,4% (SE 1,1%) and 97,5% (SE 1,4%) at 30, 180 and 365 days respectively.

Conclusion: In real-world practice, the Alto stent graft demonstrated excellent technical and clinical success with low reintervention rates at one year, including a part of patients with challenging proximal and distal anatomy.

Purpose: To report techniques, adverse events, and outcomes of endovascular recanalization and stent reconstruction for symptomatic venous ligation.

Materials and methods: In this single-center, retrospective study, nine patients (mean age, 52.9), underwent endovenous recanalization and stent reconstruction for symptomatic venous ligation between January 2014 and January 2024. Patients presented with CEAP 3 (55.6%), 4 (11.1%), and 5 (33.3%) disease. Ligation sites commonly involved the external iliac (66.7%) or femoral veins (44.4%); five patients had multisegment ligation. Etiologies included surgical injury (44.4%), trauma (22.2%), chronic venous thrombosis (22.2%), and malignant resection (11.1%). Procedural techniques, recanalization methods, stent selection, adverse events, patency, and clinical outcomes were recorded.

Results: Primary single-session recanalization was achieved in nine patients (100%). Ten procedures were performed, as one patient required reintervention for early thrombosis. Sharp extravascular techniques were required in six procedures (60%). Twenty-six stents were deployed (Wallstents, cTAG devices, SMART stents), with a mean of 2.9 ± 2.5 stents per patient and mean stent diameter of 15.5 ± 3.2 mm. One patient (11.1%) developed early stent occlusion and was unable to be recanalized. All other reconstructions remained patent (primary/secondary patency 88.9%). Mean imaging follow-up was 466.4 ± 500.3 days, and mean clinical follow-up was 1,086.2 ± 717.5 days. Adverse events included one major (10.0%; SIR class D) and one minor (10.0%; SIR class A). Clinical improvement occurred in eight patients (88.9%), including complete symptom resolution in six (66.7%). No mortality occurred.

Conclusion: Endovenous recanalization and reconstruction is a safe and effective treatment for symptomatic venous ligation.

Background: Nonhome discharge (NHD) after lower extremity bypass is associated with discharge delays, increased post-discharge complications, and reduced patient quality of life. Accurate risk assessment would enhance shared decision making, preoperative optimization, and discharge planning.

Methods: Adult patients in a statewide vascular surgery registry who underwent lower extremity bypass from January 2016 to December 2023, were analyzed. The primary outcome was NHD, defined as discharge to rehabilitation, acute care facility, nursing home/extended care, hospice, assisted living, or leaving against medical advice. Two models were developed-multivariable logistic regression and XGBoost machine learning-using predictors such as age, gender, race, comorbidities, smoking status, tissue loss, procedure urgency, and length of stay. Each model was built using (a) preoperative variables only and (b) both pre- and perioperative variables, with data split into training and testing sets. Performance was compared using area under the receiver operating characteristic curve (AUC) and calibration plots.

Results: Among 9,789 patients, those experiencing NHD were more likely to be older, female, Black, not currently smoking, have tissue loss, require a vein graft, present urgently or emergently, have longer hospital stay, higher frailty scores, and multiple assessed comorbidities. Model discrimination improved with perioperative variables (logistic regression AUC 0.760 to 0.855; XGBoost 0.755 to 0.854). No difference in predictive accuracy was found between model types (p=0.308). Models with only preoperative variables underpredicted risk in low-risk patients.

Conclusions: Both modeling approaches accurately predicted NHD, with perioperative data improving performance. Findings informed a risk calculator to support preoperative planning and discharge efficiency.

Objective: The aim of this study was to analyze the outcomes of patients with chronic limb threatening ischemia (CLTI) submitted to infrapopliteal bypass, using alternative conduits.

Methods: A single-center retrospective analysis of infrapopliteal bypass was performed between 2012 and 2023. Patients were divided in three groups based on conduits - single-segment great saphenous vein (ssGSV), heparin-bonded expanded polytetrafluoroethylene (HePTFE) and alternative autologous venous grafts (AAVG). Primary endpoint was 1-year freedom from CLTI. Secondary endpoints were recurrence of CLTI, limb salvage, survival, amputation free-survival (AFS) and primary (PP) and tertiary patency (TP) rates at 3 years of follow-up.

Results: A total of 480 infrapopliteal bypasses were performed in 424 patients with CLTI, 31% (150/480) with HePTFE and 8% (38/480) with AAVG. Median age was 72 years (interquartile range - IQR 15) and 76% (366/480) were male. Median follow-up was 23 months (IQR 42). Overall, 93% (446/480) had tissue loss and 45% (200/446) of those had some degree of infection. One-year freedom from CLTI was achieved in 77% of the overall population, with no difference between the three groups [adjusted Hazard Ratio (aHR) 0.91, CI 0.78-1.06, p=0.219]. HePTFE had higher 3-year recurrence of CLTI when compared with ssGSV (45% vs. 18%, aHR 3.80, CI 1.85-7.82, p<0.001). No differences were observed between ssGSV and AAVG regarding 3-year recurrence of CLTI, limb salvage, survival, AFS, PP and TP.

Conclusions: In the absence of an adequate ssGSV conduit, both AAVG and HePTFE grafts proved to be suitable alternatives for infrapopliteal bypass. When feasible, AAVG should be preferred over HePTFE grafts.

Introduction: Lower extremity access remains a last resort for many patients needing dialysis. The role antiplatelets or anticoagulants (AC) play on their patency is unknown. We sought to identify the effects of antiplatelet or AC therapy prescribed at discharge on patency and survival in patients undergoing creation of lower extremity dialysis access.

Methods: All patients in the Vascular Quality Initiative dialysis module with a lower extremity AV fistula (AVF) or AV graft (AVG) created from 2011-2023 were retrospectively analyzed. Medications prescribed at discharge were organized into aspirin (ASA), clopidogrel, dual antiplatelet (DAPT), and single antiplatelet plus anticoagulation (SAPT+AC). Univariable Kaplan-Meijer (KM) and multivariable regression analyses were utilized to assess impact of discharge medication on survival and primary/secondary patency.

Results: 1,190 patients underwent lower extremity dialysis access creation with 151 (12.7%) receiving AVFs and 1,039 (87.3%) receiving AVGs. Of AVF patients, 41 (27.2%) were discharged on no medication, 50 (33.1%) on aspirin, 5 (3.3%) on clopidogrel, 9 (6.0%) on DAPT, and 46 (30.5%) on SAPT+AC. Following AVG creation, 348 (33.5%) of patients were discharged on no medications, 271 (26.1%) on aspirin, 59 (5.7%) on clopidogrel, 62 (6.0%) on DAPT, and 299 (28.8%) on SAPT+AC. KM analyses showed no difference in survival, primary patency, or secondary patency based on medication following AVF. Multivariable analysis showed improved secondary patency with clopidogrel alone (HR 0.08, CI 0.01-0.96, p = 0.04). Aspirin, DAPT, and SAPT + AC use showed no significant difference.

Conclusion: This analysis suggests SAPT is protective for lower extremity AVG with clopidogrel alone showing statistically significant protection. This suggests that clopidogrel as SAPT is a viable option for prolonging AVG patency if prescribed at discharge. Further study on antiplatelet usage following lower extremity dialysis access creation is warranted.