Annals of vascular surgery最新文献

{"title":"The Incidence and Significance of Iliac Vein Stenosis in Patients with Deep Vein Thrombosis","authors":"Sahar Ali ,&nbsp;Shin Mei Chan ,&nbsp;Anand Brahmandam ,&nbsp;Yunshan Xu ,&nbsp;Yanhong Deng ,&nbsp;Ahmed Elbadawy ,&nbsp;Alfred Lee ,&nbsp;Cassius Iyad Ochoa Chaar","doi":"10.1016/j.avsg.2024.11.016","DOIUrl":"10.1016/j.avsg.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>The role of iliac vein stenosis (IVS) in the development of deep vein thrombosis (DVT) is poorly understood. This study determines the incidence of IVS in patients diagnosed with DVT and assesses its impact on presentation and outcomes. Our hypothesis is that the presence of IVS increases the risk of long-term ipsilateral DVT recurrence.</div></div><div><h3>Methods</h3><div>A retrospective study of the electronic medical records of consecutive adult patients treated for lower extremity DVT was performed. Only patients with cross-sectional imaging (computed tomography or magnetic resonance with intravenous contrast) were included. Patient and DVT characteristics were recorded. Cross-sectional imaging was reviewed for the presence or absence of ipsilateral IVS (≥50%). Patients were divided into 2 groups based on the presence or absence of IVS to compare characteristics and outcomes. Subgroup analyses on patients with provoked DVT, cancer-related DVT, and unprovoked DVT were performed.</div></div><div><h3>Results</h3><div>There were 548 patients with DVT and 32% had evidence of ipsilateral IVS on cross-sectional imaging. There were no significant differences in baseline characteristics or treatment methods between the 2 groups. There was a trend toward patients with IVS having less incidence of pulmonary embolism on presentation (22.9% vs. 29.7%, <em>P</em> = 0.1) but that difference did not reach statistical significance in the overall comparison. Subgroup analysis in patients with cancer-related DVT (<em>n</em> = 227) showed that patients with IVS were significantly more likely to develop ipsilateral recurrent DVT compared to patients with no IVS (12.9% vs. 4.5%, <em>P</em> = 0.045). Patients with unprovoked DVT with IVS had significantly lower pulmonary embolism on presentation than patients with unprovoked DVT without IVS (24.2% vs. 39.8%, <em>P</em> &lt; 0.03).</div></div><div><h3>Conclusions</h3><div>Ipsilateral ≥50% IVS is present in approximately a third of patients presenting with DVT. The presence of IVS seems to play a differential role in ipsilateral DVT recurrence and prevention of pulmonary embolization in different groups of patients presenting with DVT.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 310-318"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Iliofemoral Calcium Score and Major Vascular Complications within the First Year after Lower Limb Endovascular Revascularization","authors":"Raul Devia-Rodriguez ,&nbsp;Maikel Derksen ,&nbsp;Mostafa El Moumni ,&nbsp;Kristian de Groot ,&nbsp;Issi R. Vedder ,&nbsp;Clark J. Zeebregts ,&nbsp;Reinoud P.H. Bokkers ,&nbsp;Robert A. Pol ,&nbsp;Jean-Paul P.M. de Vries ,&nbsp;Richte C.L. Schuurmann","doi":"10.1016/j.avsg.2024.11.009","DOIUrl":"10.1016/j.avsg.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>The accumulation of calcium load in peripheral lower extremity arteries has been associated with increased severity of peripheral artery disease (PAD) and mortality. While calcium scores are commonly calculated from non-contrast computed tomography (CT) scans, patients with PAD often undergo contrast-enhanced CT scans. This study aims to explore the association between a length-adjusted calcium score (LACS) of the iliofemoral arteries, determined through pre-intervention contrast-enhanced CT, and major adverse events in patients with chronic limb-threatening ischemia (CLTI).</div></div><div><h3>Methods</h3><div>A cohort of CLTI patients subjected to endovascular revascularization between 2005 and 2017 at a tertiary referral center were categorized into 2 groups. The complication group experienced one of the composite outcomes (reintervention, above-the-ankle amputation, and/or all-cause mortality within 1 year of the primary endovascular procedure), while control patients did not encounter this composite endpoint. Patients from the complication group were matched one-to-one with controls based on sex and Fontaine classification. LACS was calculated (Ca volume[mm³]/length[cm]) at 3 arterial segments; 1. the common iliac artery (CIA), 2. the external iliac artery and common femoral artery (EIA + CFA), and 3. the superficial femoral artery plus the popliteal artery (SFA + PA). Binary logistic regression analysis was conducted to investigate the association between LACS in the different arterial segments and the occurrence of the composite binary outcome (complication and control) and LACS of the different segments, adjusting influences of age, sex, BMI &gt;25, Fontaine classification, diabetes mellitus type 1 &amp; 2, chronic kidney disease stage, and hemodialysis treatment.</div></div><div><h3>Results</h3><div>Sixty-four CLTI patients were included in this study (complication group [<em>n</em> = 32], and control group [<em>n</em> = 32]). A significant difference (higher LACS was found for the complication group in the CIA, the SFA + PA, as well as the total trajectory. CLTI patients with high LACS in the SFA + PA or the total trajectory were more likely to suffer adverse events (SFA + PA: OR: 1.010, 95% CI: 1.000–1.020, <em>P</em> = 0.04; Total LACS: OR: 1.008, 95% CI: 1.000–1.017, <em>P</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>Patients with a high calcium load in the ilio-femoral arteries are at increased risk of major adverse events during 1 year after endovascular revascularization. The calcium score, derived from contrast-enhanced CT scans, holds potential utility in decision making for CLTI patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 290-298"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Negative Pressure Wound Therapy on Groin Surgical Site Infection After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia","authors":"Young Kim,&nbsp;Christina L. Cui,&nbsp;Hana S. Shafique,&nbsp;E. Hope Weissler,&nbsp;Adam P. Johnson,&nbsp;Dawn M. Coleman,&nbsp;Kevin W. Southerland","doi":"10.1016/j.avsg.2024.10.020","DOIUrl":"10.1016/j.avsg.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) are a common cause of patient morbidity, hospital readmission, and reoperation after lower extremity bypass (LEBs) surgery for chronic limb-threatening ischemia (CLTI). Recent studies on the use of incisional negative pressure wound therapy (NPWT) in LEB surgery have reported conflicting results. In this single-center study, we examined our experience on the impact of NPWT on groin SSI rates after LEB surgery.</div></div><div><h3>Methods</h3><div>We retrospectively queried electronic medical records for all LEB operations performed for CLTI. Multivariate logistic regression analysis was used to identify risk factors associated with postoperative SSI. Using these risk factors, subset analysis was performed to determine whether NPWT was associated with reduced SSI in high-risk patients.</div></div><div><h3>Results</h3><div>From 2018 to 2022, a total of 367 patients underwent LEB surgery for CLTI. Mean patient age was 66 years. Postoperative groin SSI was diagnosed in 22.9% (<em>n</em> = 84) of patients. Patients suffering SSI were more frequently morbidly obese (6.0% vs 1.8%, <em>P</em> = 0.03) and had higher rates of chronic obstructive pulmonary disease (35.7% vs 23.3%, <em>P</em> = 0.02). Other comorbidities and demographic data were similar between groups. NPWT was utilized in 19.6% (<em>n</em> = 72) of patients, with no baseline differences between SSI and no SSI cohorts (15.5% vs 20.9%, <em>P</em> = 0.28). On multivariate analysis, female sex (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.06–3.35, <em>P</em> = 0.03), white race (OR 2.17, 95% CI 1.23–3.82, <em>P</em> = 0.007), morbid obesity (OR 3.67, 95% CI 0.93–14.4, <em>P</em> = 0.05), and active smoking (OR 4.07, 95% CI 1.20–13.8, <em>P</em> = 0.02) were independently associated with postoperative SSI. Subset analysis among patients at increased risk of SSI did not reveal any differences in wound infection with NPWT usage.</div></div><div><h3>Conclusions</h3><div>In our experience, NPWT does not appear to be more effective than standard dressings in preventing groin SSI after LEB surgery for CLTI, even among populations at heightened risk for wound infection.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 143-150"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Updated Review on Arterial Stiffness Measurement Techniques and Arterial Stiffness Alterations After Aortic Aneurysm Repair","authors":"Michail Tsotsios ,&nbsp;Athanasios Katsargyris ,&nbsp;Konstantinos G. Moulakakis ,&nbsp;Evangelos Oikonomou ,&nbsp;Vasiliki Tsigkou ,&nbsp;Natasha Hasemaki ,&nbsp;Gerasimos Siasos ,&nbsp;Chris Klonaris","doi":"10.1016/j.avsg.2024.11.018","DOIUrl":"10.1016/j.avsg.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Studies over the last years have revealed the possible impact of endovascular repair of abdominal or thoracic aortic aneurysms on the arterial stiffness and secondary on the cardiac function and the central hemodynamics.</div></div><div><h3>Methods</h3><div>A literature search was conducted to collect data on current methods of arterial stiffness assessment and the induced changes in arterial stiffness after endovascular or open surgical repair of abdominal or thoracic aortic aneurysms.</div></div><div><h3>Results</h3><div>Seventeen studies were analyzed. In most of these studies, arterial stiffness, either assessed by pulse wave velocity or augmentation index, was found to be increased after aortic aneurysm repair. Factors that increase arterial stiffness seem to be endovascular repair of the aneurysm and the proximity of the stent graft to the heart. The clinical implications of increased arterial stiffness are left ventricular hypertrophy, coronary arteries malperfusion and potential end-organ damage.</div></div><div><h3>Conclusions</h3><div>Both endovascular and open aortic aneurysm repair can alter arterial stiffness, with endovascular repair having a greater effect. Future research is essential, particularly in exploring the impact of aortic aneurysm repair methods on vital organs and cardiac function. Extended follow-up studies are proposed to gain a better understanding of the long-term cardiovascular consequences of both endovascular and open surgical repair outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 299-309"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence to Enhance Future Clinical Trials in Vascular Surgery","authors":"Sebastien Goffart,&nbsp;Andréa Chierici,&nbsp;Lisa Guzzi,&nbsp;Hervé Delingette,&nbsp;Ahmed Alouane,&nbsp;Fabien Lareyre,&nbsp;Juliette Raffort","doi":"10.1016/j.avsg.2024.11.019","DOIUrl":"10.1016/j.avsg.2024.11.019","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 331-335"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid Ultrasound Assessment Prior to Coronary Artery Bypass Grafting – An Irish Cardiac Surgery Center's Experience","authors":"John David Kehoe ,&nbsp;Amber Downes ,&nbsp;Aoife Feeley ,&nbsp;Sean Barrett ,&nbsp;Carl Vaughan ,&nbsp;Tara Ni Dhonnchu","doi":"10.1016/j.avsg.2024.10.012","DOIUrl":"10.1016/j.avsg.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Carotid stenosis is a risk factor for cerebrovascular accident (CVA) following coronary artery bypass grafting (CABG). Guidelines recommend selective preoperative screening with Doppler ultrasound (US) but nonselective application is commonplace. Recent data has questioned the efficacy of perioperative carotid intervention, challenging the value of this practice. We thus aimed to analyze the utility of carotid US assessment prior to CABG in our institution.</div></div><div><h3>Methods</h3><div>This was a retrospective review of all patients over 18 that underwent a nonemergency CABG in a single Irish cardiac surgery center from January 2019 to December 2022.</div></div><div><h3>Results</h3><div>1161 subjects were included. 1084/1161 (93.36%) underwent US assessment. 41/1084 (3.8%) had ≥70% stenosis and 189/1084 (17.5%) had ≥50% stenosis. 32/1084 (2.95%) underwent confirmatory imaging and 7/1084 (0.64%) underwent carotid intervention. Postoperative CVA occurred in 18/1161 (1.55%) and ≥70% (<em>P</em> = 0.024) and ≥50%(<em>P</em> &lt; 0.001) carotid stenosis were associated with same.</div><div>Chronic kidney disease (odds ratio [OR] = 1.66,<em>P</em> = 0.01), decreasing hemoglobin (OR = 1.13,<em>P</em> = 0.019), increasing age (OR = 1.03,<em>P</em> = 0.011) and being a current (OR = 3.21,<em>P</em> &lt; 0.001) or ex-smoker (OR = 1.82,<em>P</em> = 0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease (CAD) was not associated with carotid stenosis (<em>P</em> = 0.563).</div><div>Of those that underwent carotid intervention, 0/7 (0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70% (<em>P</em> = 1) or ≥50% (<em>P</em> = 1) carotid stenosis.</div></div><div><h3>Conclusions</h3><div>Carotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel CAD was not associated with carotid stenosis despite European guidelines listing it as screening criteria. Predictive models must be developed using identified risk factors to enable targeted preoperative screening.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 176-186"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Not Mix It up! Long-Term Outcomes of Different Proximal Aortic Cuffs with the AFX Endograft","authors":"Giulio Accarino ,&nbsp;Aniello Enrico Puca ,&nbsp;Antonia Rinaldi ,&nbsp;Giovanni Fornino ,&nbsp;Giancarlo Accarino ,&nbsp;Davide Turchino ,&nbsp;Raffaele Serra ,&nbsp;Sergio Furgiuele ,&nbsp;Carmine Vecchione ,&nbsp;Umberto Marcello Bracale","doi":"10.1016/j.avsg.2024.10.024","DOIUrl":"10.1016/j.avsg.2024.10.024","url":null,"abstract":"<div><h3>Background</h3><div>The AFX unibody endograft offers advantages in treating abdominal aortic aneurysms (AAAs) with narrow aortic bifurcations due to its unique design, where the flow divider sits at the native aortic bifurcation. However, its limited length options may limit complete proximal neck utilization. As per device instruction for use, the implant should be completed with an aortic cuff. This study aims to evaluate the long-term outcomes of patients treated with an all-Endologix implant versus a combination of Endologix and Medtronic devices.</div></div><div><h3>Methods</h3><div>This retrospective, single-center study included 134 consecutive AAA patients who underwent endovascular aneurysm repair (EVAR) using the AFX unibody endograft paired with suprarenal aortic cuffs from Endologix (<em>n</em> = 86) or Medtronic (<em>n</em> = 48) between November 2011 and November 2022. Patients were divided into 2 groups based on the type of aortic cuff used. The primary outcome was the occurrence of type 3A endoleaks at the longest available follow-up. Secondary outcomes included any endoleak, reintervention rates, all-cause mortality, and aneurysm-related death.</div></div><div><h3>Results</h3><div>The median follow-up was 41 months, and type 3A endoleaks occurred after a mean 34.8 months in 6 patients (4.5%), which is significantly more frequent in the mixed-device group (12.8%) (<em>P</em> &lt; 0.001). Type 3A endoleak occurred regardless of overlap and developed over time. Endoleaks of any type were reported in 17 patients. Reinterventions were needed in 12 patients. The use of an Endurant cuff was associated with a significantly increased risk of type 3A endoleaks (hazard ratio [HR] 16.5; 95% [CI] 1.9–143; <em>P</em> = 0.011) and reinterventions (HR 9.67; 95% CI 1.9–49.6; <em>P</em> = 0.006).</div></div><div><h3>Conclusions</h3><div>Combining endografts from different manufacturers, especially those with differing materials and sealing mechanisms, may compromise the long-term integrity of certain EVAR repairs. Clinicians should exercise caution when considering mixed-device configurations and ensure rigorous follow-up for patients with such implants.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 122-130"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Endovascular Interventions via Percutaneous Access to the Axillary Artery","authors":"Caleb D. Alterman,&nbsp;Anton D. Perera,&nbsp;Prateek K. Gupta,&nbsp;Daniel M. Alterman","doi":"10.1016/j.avsg.2024.10.018","DOIUrl":"10.1016/j.avsg.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular treatment of peripheral arterial disease requires safe and reliable arterial access. This study evaluates the feasibility and safety of percutaneous axillary artery access for endovascular therapy. A variety of anatomic and logistic obstacles can be overcome with upper extremity access. In this retrospective case review, we describe our experience with percutaneous trans-axillary access for lower extremity peripheral arterial disease intervention.</div></div><div><h3>Methods</h3><div>Medical records of all patients undergoing axillary artery percutaneous access from December 2021 to August 2024 were reviewed. Demographic data, procedural details, and complications such as pseudoaneurysm, hematoma, nerve injury, and closure device success were analyzed. Technical success and perioperative complications—including bruising, edema, hematoma, nerve injury, infection, thrombosis, and pseudoaneurysm—were assessed. Clinical outcomes were analyzed via follow-up clinic records.</div></div><div><h3>Results</h3><div>During the study period, 79 axillary artery accesses were performed on 64 patients. The patients were 55% male and had typical vascular comorbidities: hypertension (87%), hyperlipidemia (68%), coronary artery disease (27%), stroke (19%), and diabetes (16%); 58% were active tobacco users, and 80% were former tobacco users. Axillary access facilitated peripheral endovascular procedures, including iliac intervention (55), femoral (44), mesenteric (16), tibial (11), and embolization or visceral aneurysm treatments. A 6F sheath and ultrasound-guided Angio-Seal closure device were uniformly employed, with no major complications, perioperative deaths, or reoperations required. Minor complications of bruising and edema were present in 11 patients (14%). Other minor complications such as hematoma, nerve injury, thrombosis, dissection, pseudoaneurysm, or limb ischemia were absent.</div></div><div><h3>Conclusions</h3><div>Percutaneous axillary artery access demonstrates promise for complex endovascular interventions with a favorable safety profile. Advantages include avoidance of unfavorable femoral anatomy, improved working length compared with radial access, and enhanced control of visceral therapy. Bilateral iliac and lower extremity therapy is feasible in a single treatment as well. Percutaneous axillary artery access is a safe, reliable adjunct for enhancing endovascular arterial intervention capabilities.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 194-202"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Thrombotic Syndrome Morbidity in Mechanical Thrombectomy Versus Pharmacomechanical Catheter-Directed Thrombolysis of Iliofemoral Deep Venous Thrombosis","authors":"Jack K. Donohue ,&nbsp;Kevin Li ,&nbsp;Anthony Tang ,&nbsp;Rachel J. Kann ,&nbsp;Lena Vodovotz ,&nbsp;Adham N. Abou Ali ,&nbsp;Rabih A. Chaer ,&nbsp;Natalie D. Sridharan","doi":"10.1016/j.avsg.2024.11.007","DOIUrl":"10.1016/j.avsg.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Iliofemoral deep venous thrombosis is strongly associated with post-thrombotic syndrome (PTS). Interventional treatment options include catheter-directed thrombolysis and pharmacomechanical thrombectomy. More recently, there has been a wide dissemination of large-bore devices for mechanical thrombectomy (MT). Both treatment types have been shown to be effective in clinical practice; however, the rates of PTS after MT are poorly characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients with acute iliofemoral deep venous thrombosis from 2007 to 2022. Patients were divided into 2 treatment groups: pharmacomechanical catheter-directed thrombolysis (PCDT) and MT with large-bore devices. Our primary endpoint was PTS (Villalta score &gt;4). Secondary outcomes included vessel patency, mortality, and moderate/severe PTS (Villalta score &gt;9). Predictors of PTS were analyzed using multivariable logistic regression.</div></div><div><h3>Results</h3><div>The median age of our cohort (<em>n</em> = 349) was 49 (interquartile range 35–63) years, 54.2% were female. There were 294 (84.2%) patients treated with PCDT. There were no significant baseline characteristic differences between patients treated with PCDT versus MT aside from increased preoperative anticoagulant use in the MT cohort. The overall rate of PTS was 19.1%. There were no differences in rates of PTS, moderate-severe PTS, stent patency, mortality between groups, or hospital length of stay. However, patients treated with MT had higher rates of single operating room visit during their admission treatment relative to patients that underwent PCDT (33.3% vs. 9.0%, <em>P</em> &lt; 0.01) and decreased intensive care unit length of stay (2 (1–3) vs. 0.5 (0–2), <em>P</em> &lt; 0.01). MT treatment was not a risk factor for the development of PTS (adjusted odds ratio [aOR] 0.73; [95% confidence interval {CI} 0.30, 1.74]; <em>P</em> = 0.47) or associated with increased Villalta score (β: −0.34; [95% CI–1.28, 0.60]; <em>P</em> = 0.47). Infrainguinal deep venous thrombosis extension (aOR 2.18; [95% CI 1.16, 4.09]; <em>P</em> = 0.02), prior deep venous thrombosis (aOR 2.67; [95% CI 1.38, 5.13]; <em>P</em> &lt; 0.01), and a hypercoagulable state (aOR 2.32; [95% CI 1.19, 4.50]; <em>P</em> = 0.01) were associated with increased risk of PTS.</div></div><div><h3>Conclusions</h3><div>Treatment with large-bore MT was not a significant predictor for the development of PTS. MT appears safe, durable, and associated with greater rates of single operating room visit relative to PCDT, which suggests that rapid thrombus removal may be of value.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 55-62"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance Index as a Prognostic Factor for Patency in Distal Lower Limb Arterial Revascularization","authors":"Isadora Ísis Fernandes Vieira ,&nbsp;Emmanuelle Tenório Albuquerque Godoi Berenguer de Barros E. Silva ,&nbsp;Gabriela de Oliveira Buril ,&nbsp;Carlos Henrique Nascimento Domingues da Silva ,&nbsp;Esdras Marques Lins","doi":"10.1016/j.avsg.2024.10.019","DOIUrl":"10.1016/j.avsg.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Critical limb ischemia (CLI) of the lower limbs (LLs) is a severe condition caused by peripheral arterial obstructive disease (PAOD). Surgical planning for CLI requires the study of limb circulation, and the vascular resistance index (RI) measured by Doppler ultrasound (US) has been used to aid in surgical decision-making. The objective is to correlate the RI of recipient arteries with the patency of LL revascularization surgeries in patients with CLI.</div></div><div><h3>Methods</h3><div>Prospective cohort study conducted from July 2021 to March 2023. The RI of the recipient arteries was evaluated preoperatively by US in 58 patients with CLI who underwent infrainguinal open or endovascular revascularizations, hospitalized in the Vascular Surgery Department of the Hospital das Clínicas of Empresa Brasileira de Serviços Hospitalares/Universidade Federal de Pernambuco. After 30 days of surgery, all patients were evaluated for the presence of pulses in the revascularized limb and the ankle brachial index (ABI) was measured in all cases. Statistical analysis was conducted with a 95% confidence level, and the Student's <em>t</em>-test was used to compare 2 independent samples.</div></div><div><h3>Results</h3><div>Clinical evaluation and ABI assessment of revascularization patency after 30 days revealed that infragenicular revascularizations that occluded had an average RI of 0.72 (SD ± 0.16), while patent revascularizations had a mean RI of 0.69 (SD ± 0.17) without statistical significance (<em>P</em> = 0.658).</div></div><div><h3>Conclusions</h3><div>Despite the lack of statistical significance, the study observed that a lower preoperative RI of the distal recipient artery was associated with greater patency of the revascularization surgery after 30 days.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 360-366"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}