Objective: To evaluate the safety and efficacy of excimer laser ablation (ELA) combined with drug-coated balloon(DCB)in the treatment of Chronic limb-threatening ischemia (CLTI) patients with de novo and in-stent restenosis (ISR) lesions in the femoropopliteal artery.
Methods: A retrospective, single-center analysis was performed on data collected between January 2017 and December 2021. The study included CLTI patients who underwent treatment with ELA combined with DCB for de novo and ISR lesions in the femoropopliteal artery. The primary endpoint was the 24-month primary patency rate. Secondary endpoints included technical success rate and the incidence of major adverse events (MAEs), defined as death, major limb amputation, or target vessel revascularization.
Results: A total of 44 patients were included in the study, comprising 24 cases in the de novo lesion group and 20 cases in the ISR group. The mean patient age was 73.4±7.7years, with approximately one-third presenting with concomitant chronic coronary artery disease or cerebrovascular disease. Around one-third of the patients exhibited foot ulcers or gangrene, with a mean lesion length of 239.09±120.09 mm. In the de novo lesion group, 79.2% of lesions were classified as chronic total occlusions (CTOs), whereas 75% of lesions in the ISR group were categorized as Tosaka III. For such complex lesions, the technical success rates were 100% in both groups. The primary patency rates for the de novo group were 86.9% at 12 months and 64.3% at 24 months, compared to 77.0% and 56.5% in the ISR group. Freedom from target lesion revascularization (TLR) rates in the de novo group were 95.8% and 85.4% at 12 and 24 months, respectively, while the ISR group achieved rates of 88.9% and 76.6%. Despite lower primary patency and freedom from target lesion revascularization rates in the ISR group, the differences were not statistically significant (P=0.74).Major adverse events were observed in 12.5% of patients in the de novo group and 35% in the ISR group, with no statistically significant difference (P=0.27).
Conclusion: For CLTI patients with complex lesions, including extensive occlusions and severe calcification, the combination of ELA and DCB demonstrates high technical success and favorable safety profiles for both de novo and ISR lesions. Mid-term outcomes indicate a potential trend toward better efficacy in treating de novo lesions compared to ISR lesions.
Objective: The Achilles' heel of infrainguinal bypass grafts (IIBG) is restenosis. Duplex ultrasound (DUS) surveillance is commonly undertaken to identify restenosis allowing intervention for graft salvage. We report the impact of DUS surveillance on patient outcomes alongside healthcare-associated costs.
Methods: Consecutive patients undergoing IIBG at our Institution were included (January 2017 - December 2020). Data on DUS surveillance (1-, 6- and 12-month scans) were collated. Primary outcome was lower limb salvage rates at 2 years. Graft failure was defined by radiological evidence of significant graft stenosis ("at risk") or occlusion (with or without symptoms). Institutional costs for treatment associated with at-risk grafts were quantified. Follow-up was 100% complete at 2-years.
Results: 254 patients had IIBG (196 men, median age 70yrs). Of those, 192 patients (76%) entered DUS surveillance, and 109 (43%) completed it. In patients who completed surveillance (vs incomplete vs none) major lower limb amputation rates were 6.4% (vs 12% and vs 30%, p= .174 and p< .001 respectively). Enrolling in DUS surveillance was associated with improved limb salvage and survival rates compared to having no surveillance at all (Log rank p < .001). Managing graft failure led to 372 additional cross-sectional imaging studies, 302 outpatient reviews, 1 538 hospital admission days and 226 open and endovascular re-interventions, with a total additional NHS cost of £ 1 436 085 / €1 683 912. Enrolment into a surveillance programme was associated with higher costs.
Conclusion: Enrolling in DUS surveillance following IIBG is associated with improved outcomes. Graft failure and its subsequent management confers additional costs. DUS surveillance is costly, but may be justified by improved limb-salvage rates and the associated reduction in amputation-associated costs.
Introduction: This study compared outcomes of patients with acute limb ischemia (ALI) before, during, and after the COVID-19 pandemic, hypothesizing that poor outcomes observed during the pandemic have not yet been resolved.
Methods: This retrospective, observational, single-center study analyzed ALI patients from 2019 to 2023.
Results: Over five years, 298 patients underwent surgery for ALI at our hospital: 35 had COVID-19 (COVID Group), 132 tested negative (Non-COVID Group), 71 were treated before the pandemic (Pre-COVID Group), and 60 after (Post-COVID Group). In 2020, 32% of ALI patients had COVID-19, a percentage that decreased over time. Baseline characteristics shifted, influencing treatment. The Pre-COVID Group had more cardiac disease with embolic ALI and required mainly embolectomy; the COVID Group had worse clinical conditions, undergoing embolectomy or amputation. The Post-COVID Group had more thrombotic ALI, with increased bypass surgery needs. Prolonged ischemia time was a concern during the entire study; 29% of patients presented with Rutherford III ischemia at admission, and 35.2% required major amputations. COVID Group had higher mortality (48.6% vs. 15.5% Pre-COVID, 22.7% Non-COVID, and 28.3% Post-COVID, P=0.003). Additional factors contributing to mortality included older age (OR 1.05 CI 1.02-1.08, P<0.001), prior stroke (OR 2.38, CI 1.07-5.38, P<0.001), COPD (OR 1.88, CI 0.53-6.59, P=0.03), and aorto-iliac ALI (OR 8.72, CI 1.25-22.63, P<0.01).
Conclusion: Delayed presentations of ALI patients persisted before, during, and after the pandemic, resulting in many cases of irreversible ischemia at admission and increased amputation rates. Mortality rates correlated with COVID-19, older age, COPD, prior stroke, and aorto-iliac involvement.
Objective: This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms.
Methods: We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion.
Results: Forty patients underwent open surgical conversion (graft replacement, n=9; graft preservation, n=31). There were no significant differences in patient characteristics or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, P < .001 and 710 vs. 2,567 mL, P = .030, respectively). There was no difference in the occurrence of postoperative complications between the two groups (P = .645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (P = .789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (P = .239).
Conclusions: Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.
Background: Venous thromboembolism (VTE) is a significant morbidity following major open abdominal surgery. While there are clear recommendations for perioperative and post-discharge VTE chemoprophylaxis in general surgery, guidance for vascular patients is unclear. We compared the incidence of VTE in vascular versus general surgery cases and then investigated the timing of VTE in vascular patients.
Methods: Two cohorts of major open abdominal surgery, vascular (open abdominal aortic aneurysm and aortoiliac reconstruction) and general, were compared in ACS-NSQIP database. There were significant preoperative differences between cohorts that were corrected using 1:1 propensity matching and logistic regression. Thirty-day outcomes included incidence and timing of VTE (in-hospital and post-discharge), mortality, and major morbidities.
Results: After propensity matching, there were 14,983 and 15,075 patients had vascular and general surgery, respectively. VTE rate was significantly lower in vascular. The distribution of in-hospital and post-discharge VTE was similar in both groups. Over the last 10 years, the overall incidence of VTE has decreased for both general and vascular surgery, with a corresponding decrease in in-hospital VTE but no change in post-discharge VTE. VTE occurrence showed a bimodal distribution with 76.92% of VTE occurring in early period (<14 days) and 23.08% occurring in late period (>14 days), which coincided with in-hospital (77.91%) and post-discharge (22.09%), respectively.
Conclusion: Although VTE incidence after vascular procedures has decreased, in-hospital VTE may be further reduced if pre-induction subcutaneous heparin is given. Furthermore, 22% VTE developed post-discharge in vascular patients, which suggests post-discharge VTE prophylaxis should be considered in selected high-risk patients.
Objective: Fever is a classic symptom in postoperative period, but to our knowledge no study shows exclusively the occurrence of fever after open aortic repair (OAR) and explores the difference between explained and unexplained fever.
Methods: Patients who underwent an OAR between March 2018 to April 2023 in Reims University Hospital were enrolled retrospectively. The primary endpoint was the rate of fever after OAR, which was classed in explained fever group (eFG) or unexplained fever group (uFG). Secondary outcomes were to compare fever characteristics, length of hospitalization, and mortality all causes at day 30 and day 90 between groups.
Results: The occurrence of fever was 23,8% after OAR, and 52% of them were unexplained. Date of occurrence of fever was at mean 3,3 days in uFG versus 7,8 days in eFG (p=0,0051). Sixty-six percent of eFG had a diagnosis of pneumopathy. The duration of hospitalization was longer in eFG vs. uFG (25 vs. 15 days) and no statistical difference was found for the mortality in both groups. After at mean 806 days of follow-up in uFG, there was no occurrence of vascular graft infection.
Conclusions: Fever after OAR occurred in a quarter of OAR patients and half of them were unexplained. Unexplained fever occurred earlier than eFG.
Background: Penetrating carotid artery injuries (CAI) are rare with high morbidity and mortality. We aimed to perform a systematic review of the published literature to evaluate the workup and management of penetrating CAI.
Methods: Studies of acute management of adult trauma patients with penetrating common or internal carotid artery injuries on MEDLINE or EMBASE from 1946 through July 2024 were included following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement methodology. Exclusion criteria was case series with <5 patients, review articles, animal studies, cadaver studies, non-English language, and age<18. Risk of bias was assessed with Oxford Level of Evidence and findings evaluated via GRADE.
Results: Our systematic review identified 4737 studies, of which 35 were included. Preoperative evaluation transitioned to screening CTA of the neck in the absence of hard signs. Management now includes endovascular and nonoperative in select cases: nonoperative for some small intraluminal injuries and stenting or embolization for surgically inaccessible lesions. Repair or revascularization was preferred in all but neurologically devastated comatose patients, in which, ligation was deemed acceptable. Temporary intravascular shunting (TIVS) with a takeback for definitive revascularization was associated with a 100% stroke or death. Postoperative antiplatelet or anticoagulation therapy and follow-up was non-standardized with a shift toward antiplatelet therapy for all injuries described more recently.
Conclusions: Penetrating CAI remain challenging with a shift toward less invasive initial workup with CTA and management including endovascular and nonoperative in select cases. TIVS with delayed revascularization and ligation were both associated with poor outcomes. Postoperative antiplatelet therapy has become increasingly common and postoperative surveillance is not standardized.
Objective: Pigs have long been employed as an animal model for knee-related diseases. However, vascular anatomy around the pig knee is rare. The objective of this study was to explore the vascular anatomy around the pig knee from the perspective of comparative medicine.
Materials and methods: Fifteen fresh cadaveric hindlimbs of hybrid pigs were used in this study. The femoral artery was infused with red- or black-colored latex. The origination, course, and branches of the arteries around the pig knee were observed.
Results: The femoral artery around the pig knee has the following branches: the saphenous artery, the first descending geniculate artery, the second descending geniculate artery, several muscular branches, and the caudal femoral artery. The popliteal artery gives off the following branches: the medial sural artery, lateral sural artery, and five articular branches. The caudal tibial artery was very thin, whereas the cranial tibial artery was strong and gave off a cranial recurrent tibial artery running toward the knee joint.
Conclusion: With the help of two classic veterinary anatomy books, we described the vascular anatomy around the pig knee from the perspective of comparative medicine, which was useful for vessel-related studies using pig knees and was conducive to academic communication.
Introduction: The Rutherford Classification for chronic limb-threatening ischemia (CLTI) is used to categorize peripheral artery disease severity through history and physical examination. This study investigated whether higher Rutherford Classification correlates with worse clinical outcomes and could serve as a predictive tool.
Methods: In this prospective single-center study , 252 patients undergoing lower extremity revascularization were followed for three years (2020-2023). Rutherford classification was determined at presentation. Outcomes included reintervention for stenosis/occlusion, amputation rates, and mortality. Statistical analysis used chi-squared tests for categorical data and one-way ANOVA for continuous data.
Results: Higher Rutherford classifications (3-6) showed increased reoperation rates versus lower classifications (28.2% vs 10.3%, p=0.043), with the largest increase between classes 2 and 3 (4.7% to 26.8%). Amputation rates were significantly higher in classifications 4-6 versus 0-3 (31.9% vs 7.2%, p<0.001), particularly between classes 4 and 5 (19.0% to 37.6%). Mortality rates were also higher in classes 4-6 versus 0-3 (22.6% vs 7.2%, p<0.001).
Discussion: Rutherford Classification effectively predicts major adverse outcomes, with marked increases at specific classification transitions suggesting critical thresholds for risk stratification. Early intervention may be warranted in higher classifications. These findings support its use as a valuable prognostic tool in preoperative planning and patient counseling.
Conclusion: This study validates Rutherford Classification as an effective tool for predicting adverse outcomes in CLTI patients. The clear correlation between higher classifications and increased complications supports its use in clinical decision-making, risk stratification, and determining optimal timing for surgical intervention.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：