Annals of vascular surgery最新文献

Objective: Currently, carotid blowout syndrome (CBS) is mainly treated with endovascular treatments, including embolization and stent grafting. However, the optimal treatment strategy remains a topic of debate. This paper aims to thoroughly assess the overall efficacy of endovascular therapies for CBS and to systematically compare the clinical outcomes and complications between embolization and stent grafting.

Methods: Medline, EMBASE, and the Cochrane Library were searched from inception to April 28, 2024. The comparison between embolization and stent grafting was determined based on the primary or secondary outcomes. Recurrent bleeding and complications were the primary outcomes. Secondary outcomes included postoperative mortality and 1-year mortality. Newcastle-Ottawa scale was used to evaluate the methodological quality of the cohort studies.

Results: There were no randomized studies among the total of 31 studies included in the analysis, which comprised 16 single-arm and 15 two-arm studies and involved 1,824 patients. The Newcastle-Ottawa Scale evaluation produced an average score of 7.19, reflecting medium to high quality across the studies. The pooled results from these cohort studies revealed a significantly higher risk of postoperative rebleeding [odds ratio (OR) = 2.18, 95% confidence interval (CI) 1.24-3.83; P = .01] and complications (OR = 1.91, 95%CI 1.15-3.19; P = .01) in the stent grafting group compared to the embolization group. However, there were no statistically significant differences in the risks of postoperative mortality (OR = 1.27, 95%CI 0.73-2.23; P = .40) or 1-year mortality (OR = 0.77, 95%CI 0.41-1.45; P = .42) between the stent grafting and embolization groups. Given that the included studies are primarily cohort studies, further prospective, multicenter research is necessary to validate these findings.

Conclusion: Patients with CBS in the stent grafting group demonstrated a significantly higher risk of postoperative rebleeding and complications compared to those in the embolization group. While embolization is a feasible approach for treating CBS, its long-term outcomes remain uncertain.

Objective: Juxtarenal abdominal aortic aneurysms (JRAAAs) represent 16% of all AAAs and pose challenges due to their proximity to the renal arteries. Standard EVAR is unsuitable, necessitating advanced techniques such as fenestrated EVAR (FEVAR) and chimney EVAR (ChEVAR), which carry increased risks. Octogenarians are an expanding demographic, but evidence on JRAAA repair outcomes in this group is limited. This study evaluates outcomes of JRAAA repair in octogenarians using data from the Dutch Surgical Aneurysm Audit (DSAA).

Methods: This nationwide retrospective cohort study analyzed DSAA data on elective JRAAA repairs (2016-2023). Outcomes in octogenarians were compared between open surgical repair (OSR) and complex endovascular aneurysm repair (cEVAR). In addition, outcomes in octogenarians were compared with those in non-octogenarians, stratified by treatment modality. The primary endpoints were textbook outcome (TO) and failure-to-rescue (FTR); secondary endpoints included 30-day mortality and postoperative complications.

Results: Among 1,655 patients, 237 (14%) were octogenarians. Octogenarians had TO in 57% of cases, with higher rates following cEVAR than OSR (66% vs. 41%; p=0.010). Complication rates were significantly lower with cEVAR (24% vs. 53%; p<0.001), as were ICU admissions (38% vs. 89%; p<0.001). FTR occurred in 7%, and 30-day mortality rates did not differ significantly between cEVAR and OSR (6% vs. 9%; p=0.072).

Conclusion: Octogenarians undergoing JRAAA repair are at greater risk of dying and experiencing complications compared to non-octogenarians. cEVAR demonstrates fewer complications, reduced resource utilization, and more favorable perioperative outcomes compared to OSR, supporting its role as a safer alternative. Individualized risk assessment and further research on predictive models and cost-effectiveness are crucial for optimizing management in this high-risk group.

Background: Total arch replacement combined with the frozen elephant trunk (FET) technique has become the predominant surgical strategy for acute type A aortic dissection (ATAAD); however, reconstruction of arch vessel perfusion remains technically demanding and often results in prolonged ischemia associated with branch vessel reconstruction.

Methods: This retrospective single-center study included all patients who were diagnosed with ATAAD and underwent surgical treatment between January 2024 and June 2025. Patients were allocated to either the cuff anastomosis combined with a single-branched FET group or the control group, and baseline characteristics, intraoperative data, and short-term clinical outcomes were compared.

Results: Among the 85 enrolled patients (mean ± standard deviation age 55.00 ± 10.36 years; 17.6% female), 40 (47%) underwent cuff anastomosis combined with a single-branched FET prosthesis. Compared with controls, these patients demonstrated significantly shorter duration of surgery, aortic cross-clamp time, and circulatory arrest time (P < 0.05). They also exhibited lower incidences of acute heart failure, systemic inflammatory response syndrome, and postoperative hepatic dysfunction (P = 0.009; P = 0.013; P = 0.034).

Conclusion: In this retrospective single-center cohort, the surgical technique of cuff anastomosis combined with a single-branched FET prosthesis was associated with shorter operative duration and fewer postoperative complications, and may be a new choice for clinically effective simplification of surgical methods.

Background: Fenestrated and branched endovascular aortic repair (F-BEVAR) is a safe and effective treatment for complex aortic aneurysms. However, the risk of postoperative renal impairment in patients with a solitary functional kidney (SFK) remains unclear. The aim of this study was to evaluate the mid-term outcomes after F-BEVAR in this patient group.

Methods: Consecutive patients who underwent F-BEVAR between 2016 and 2021, including nine patients with SFK, were included from a prospectively managed database. Endpoints were the occurrence of acute kidney injury (AKI) according to the RIFLE criteria, deterioration of renal function, initiation of dialysis, and mortality between the two groups. Predictive factors were determined by univariate and multivariate analyses.

Results: A total of 124 patients (65.3% male, 71.4 ± 8.6 years old), including nine patients with one SFK (7.3%) and 115 (92.7%) with two functioning kidneys, were analyzed. Stage III and IV chronic kidney disease (CKD) was significantly more common in the SFK group (77.8% vs. 26.1%, P = 0.003), with a significantly higher number of patients with stage IV CKD (22.2% vs. 2.7%, P = 0.004). Postoperative AKI incidence was similar in the SFK and control groups (22.2% vs. 21.7%, P = 0.973). At a mean follow-up of 24 months, deterioration of renal function (>25% decrease in eGFR) occurred in 44.4% of SFK patients vs. 20.9% of the control group (P = 0.120)); permanent dialysis was significantly more frequent in the SFK group (22.2% vs. 0.9%, P = 0.0001); and survival at 1 and 3 years did not differ significantly between groups. SFK was not predictive of AKI within the first 30 days or during follow-up. Postoperative AKI was a significant predictor of progression of CKD and mid-term mortality.

Conclusion: The study found similar rates of postoperative acute renal failure and mortality between patients with a single functioning kidney (SFK) and those with two kidneys, but long-term dialysis was more frequent in SFK patients. Postoperative acute renal failure predicted chronic kidney failure and long-term mortality, suggesting that renal outcomes are more closely related to baseline kidney function than kidney volume.

Background: Ruptured aortic aneurysm (rAA) is a life-threatening vascular emergency, often fatal before reaching medical care. Despite advances in screening, endovascular repair, and cardiovascular risk control, mortality from rAA remains high. This study aimed to evaluate national trends and disparities in rAA-related mortality among the US adults from 1999 to 2020.

Methods: A retrospective population-based analysis was performed using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality data for adults aged ≥25 years. Deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th revision codes I71.1, I71.3, I71.5, and I71.8. Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 US standard population. Temporal trends were assessed with Joinpoint regression to estimate annual percent change and average annual percent change (AAPC) with 95% confidence intervals.

Results: rAA led to 118,211 deaths in the United States from 1999 to 2020. The overall AAMR was 2.50 per 100,000, declining from 4.87 in 1999 to 1.15 in 2020 (AAPC = -6.51%). Mortality was higher in men (3.70) than women (1.62) and in rural (3.04) compared to urban areas (2.37). Non-Hispanic (NH) Whites had the highest rates (2.74), while NH Asians showed the steepest decline (AAPC = -7.02%). Regionally, the Midwest recorded the highest AAMR (2.94), whereas the Northeast showed the fastest decline (AAPC = -6.83%). Mortality increased sharply with age, peaking in adults ≥85 years.

Conclusion: The US mortality due to rAA has decreased significantly over a period of 20 years, although the underlying factors for this decline cannot be determined from mortality data alone. Nevertheless, this reduction was not even, as women, older adults, and rural residents continue to face disproportionately higher mortality. Ongoing surveillance and targeted efforts to address disparities in access to care are needed to maintain and extend these gains.