Background: Thoracic Endovascular Aortic Repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, penetrating traumatic aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI.
Methods: Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011-2022. Patients with blunt and penetrating injuries were compared based on pre-operative characteristics, injury severity, and post operative outcomes.
Results: TEVAR was performed for 1,867 patients with traumatic aortic injuries of which 1808 (96.9%) patients had BAI, and 59 (3.1%) had PAI. The majority of injuries being treated were either grade 3 (pseudoaneurysm) (55.3%) or grade 4 (transection) (16.4%). PAI patients had a higher proportion of grade 4 injuries compared to BAI (36.4% vs. 16.5%, p=0.001). The majority of PAI were in zones 4-5 (61.1% vs. 14.2%, p<0.001), whereas the majority of BAI were in zone 3 (66.5% vs. 16.7%, p<0.001). Overall, the mortality rate was 8.2% (N=154). In hospital mortality was 8.5% in the PAI group and 8.2% in the BAI group (p=0.813). There was no significant difference in major complication rates between PAI and BAI patients.
Conclusions: PAI occurs more commonly in zones 4-5 of the thoracic aorta and often presents with higher grade aortic injury when compared to BAI. TEVAR for PAI provides excellent in-hospital survival, especially compared to historical mortality rates around 40%. An endovascular first approach may lead to improved survival for PAI.
Background: Although guidelines have established endovenous laser ablation (EVLA) as the first-line option for patients with varicose veins (VVs) in chronic Great saphenous vein (GSV) insufficiency, however, Chronic Vein Insufficiency (CVI) remains a significant healthcare burden. Endovenous microwave ablation (EMA) is a promising alternative. This review aims to analyze the Endovenous Microwave Ablation versus Endovenous Laser Ablation for Varicose Veins in Chronic Great Saphenous Vein Insufficiency METHODS: Randomized controlled trials (RCTs) and cohort studies across PubMed, Scopus, Science Direct, and the Cochrane Library up to November 11, 2024 was searched. Risk of bias was evaluated using Cochrane Risk of Bias Tool for RCT and Newcastle-Ottawa Scale (NOS) for Cohort studies. Meta-analysis was done using RevMan 5.4.0 using an inverse-variance random-effects model with Duval and Tweedie trim-and-fill sensitivity analysis.
Results: Overall, a total of 2 RCTs and 1 cohort study included. In treating GSV VVs, EMA has proven to have shorter duration of operation significantly compared to EVLA (MD: -6.62 [95% CI: -11.91, -1.32, p = 0.01]) although heterogeneity is high. EMA have similar profiles in efficacy compared to EVLA (Aberdeen score of QoL, VAS Score, length of hospital stays, and recanalization rate in 6-months). In terms of safety, the incidence of ecchymosis was found to be lower in the EMA group compared to the EVLA group significantly (OR: 0.58). Other safety profiles were found to be similar.
Conclusion: EMA might lower operating time, potentially reducing procedure risks, and is equally effective as EVLA in treating VVs in chronic GSV insufficiency. Further research comparing these techniques with extended follow-up periods (over 12 months) and standardized study methodologies are still needed.
Objective: Chronic limb-threatening ischemia (CLTI) requires revascularization whenever it is possible. The great saphenous vein represents the surgical conduit of choice. However, it is not always available, in particular in multi-operated patients. In such cases, alternative efficient biological conduits are needed but data remains limited. This study aims at evaluating the performance of cold stored venous allografts provided by Bioprotec® society.
Methods: Prospective multi-center cohort. The primary endpoint was limb salvage rate at one year following revascularization with cold stored venous allografts. Follow-up based on clinical examination and duplex-scan. Uni- and multivariate analyses were performed to analyze predictive factors of endpoints.
Results: Overall, 39 patients (40 limbs) were included between 2018 and 2021. Patients had a median of 2 [0-6] revascularizations prior to inclusion. A total of 97 grafts were used (median of 3 [1-4] grafts per procedure). In the postoperative period (30 days) no death and 4 major amputations were noted. The median length of follow-up was 13.4 [0.7-31.1] months. The six-months, one-year and two-year freedom from major amputation rates were 79% [95% CI: 68-93], 75% [95% CI 62-91] and 68% [95% CI: 51-90], respectively. The six months, one-year and two-year survival rates were 95% [88-100], 83% [95% CI: 71-98] and 79% [95% CI: 65-96], respectively. Primary patency rates were 77% [95% CI: 64-91] at six months, and 47% [95% CI: 32-70] at one and two years. Secondary patency rates were 82% [95% CI: 70-95] at 6 months and 50% [95% CI: 34-73] at one and two years. The analysis identified the number of previous revascularizations as a significant risk factor for graft patency (Hazard Ratio: 1.59; 95% Confidence Interval: 1.13-2.24).
Conclusion: Revascularization of CLTI patients with previous failed interventions is highly challenging. The use of cold stored venous allograft showed encouraging limb salvage rate despite modest patency rates and thus may represent an alternative to other substitute in some selected cases. More studies are necessary to identify the potential of CSVA in CLTI patients.
Background: Nonocclusive mesenteric ischemia (NOMI), a subtype of acute mesenteric ischemia, is primarily caused by mesenteric arterial vasoconstriction and decreased vascular resistance, leading to impaired intestinal perfusion.Commonly observed after cardiac surgery, NOMI affects older patients with cardiovascular or systemic diseases, accounting for 20-30% of acute mesenteric ischemia cases with a mortality rate of ∼50%. This review explores NOMI's pathophysiology, clinical implications in aortic dissection, and the unmet needs in diagnosis and management, emphasizing its prognostic significance.
Methods: A comprehensive literature review was conducted using multiple electronic databases to extract relevant data and information.
Results: NOMI is a life-threatening condition characterized by mesenteric vasoconstriction and reduced splanchnic blood flow, often triggered by cardiac surgery, haemodialysis, or hypotensive episodes. Epidemiological studies highlight its prevalence in ICU settings, with a high mortality rate linked to delayed diagnosis and systemic hypoperfusion. Risk factors include advanced age, vasopressor use, and inflammatory markers. Biomarkers such as I-FABP, citrulline, and D-lactate show potential for early detection but lack robust clinical validation. Management includes fluid resuscitation, vasodilators, and surgical intervention for bowel necrosis. Emerging endovascular approaches show promise but are limited to select cases without bowel infarction. This review underscores the critical need for timely diagnosis, risk factor identification, and tailored interventions to improve outcomes.
Conclusion: NOMI remains poorly understood despite advances in surgical and perioperative care. Its pathophysiology, linked to cardiopulmonary bypass and intraoperative factors, requires heightened clinical vigilance. Limited evidence underscores the need for a multidisciplinary approach involving surgeons, radiologists, and anaesthetists to improve diagnosis, management, and outcomes in aortic surgery patients. Figure 1. Schematic illustration of morphological and haemodynamic patterns of mesenteric ischaemia. The aortic type (A) and branch type (B) cause significant malperfusion, while mild compression of the true lumen (TL) or double tract perfusion do not cause malperfusion. AB-AO abdominal aorta, FL false lumen, SMA superior mesenteric artery. Reproduced from Orihashi et al. [REF] with copyright permission obtained.
Objectives: This study assessed the association between chronic obstructive pulmonary disease (COPD) severity and postoperative mortality among patients undergoing thoracic endovascular aortic repair (TEVAR) and complex endovascular aortic repair (CEVAR).
Methods: A retrospective review of the Vascular Quality Initiative database identified elective TEVAR and CEVAR cases from 2013-2022 with endograft proximal landing zone ≥2 for thoracic or complex abdominal aortic disease. Symptomatic disease, ruptures, and urgent/emergent surgeries were excluded. Patients were stratified by COPD severity. The primary outcome was in-hospital mortality. Secondary outcomes included respiratory complications and 1-year mortality. Multivariable logistic regression was used for in-hospital mortality, respiratory complications, and 1-year mortality.
Results: Among 11,336 patients with TEVAR and CEVAR, 66% did not have COPD, 9% had COPD not on medications, 20% had COPD on medications, and 6% had COPD on home supplemental oxygen. In-hospital mortality was 2.3%, 3.7%, 3.2%, and 4.5% (P=.0004) respectively, and was not associated with increased odds of mortality. Respiratory complications occurred in 4.3%, 4.5%, 6.4%, and 7.3% (P<.0001) and was associated with increased odds for COPD on medications (OR 1.3) and COPD on home supplemental oxygen (OR 1.7). 1-year survival was 91%, 87%, 86%, and 80% and associated with increased risk for each COPD group (HR 1.4, HR 1.4, HR 1.9).
Conclusions: Patients with COPD undergoing TEVAR and CEVAR, have increased rates of in-hospital mortality, respiratory complications, and 1-year mortality. COPD severity is independently associated with increased respiratory complications and 1-year mortality, which should be factored into preoperative decision making.
Objectives: Optimal timing for intervention for abdominal aortic aneurysms remains unclear. Given the increased rupture risk with larger aneurysms, timely intervention is critical. This study sought to examine endovascular aortic aneurysm repairs (EVAR) delays across Canadian centers, focusing on potential differences related to geography, sex and race.
Methods: The Vascular Quality Initiative (VQI) dataset was obtained for all patients who underwent elective EVAR for asymptomatic AAAs between January 11th, 2016 and October 30th, 2020 in 6 participating Canadian vascular centers. Delay was defined as the time between the date of preoperative imaging and the operative date. Univariate and multivariable analysis were performed to evaluate predictors of long delay.
Results: A total of 659 patients were included in the analysis. Geographic disparities were significant, with patients in Quebec more likely to experience delays exceeding 8 weeks compared to Ontario (OR = 4.5, 95% CI: 2.8-7.1, p < 0.001). Patients with shorter delays (≤ 8 weeks) were more likely to have an unrestricted functional status (88.0% vs. 81.9% for delay > 8 weeks, p = 0.030) and larger aneurysms (83.1% vs. 67.0% for delay > 8 weeks, p < 0.001). Perioperative and postoperative complications were similar across both groups.
Conclusion: Our study reveals significant disparities in the timing of elective EVAR cross Canadian centers, likely due to multifactorial causes. These findings highlight the need for targeted strategies to reduce delays and ensure equitable access to timely care. Future efforts should focus on improving healthcare system preparedness and addressing regional and demographic disparities.
Objective: In this study, we aimed to retrospectively review patients with post-thrombotic syndrome (PTS) and investigate its long-term outcomes, and a novel classification were presented across multiple institutions.
Methods: We retrospectively evaluated patients with PTS who underwent endovascular therapy at two institutions between January 2018 and September 2023. Baseline patient demographics, lesion characteristics, and in-hospital and follow-up outcomes were collected and analyzed retrospectively.
Results: 83 patients (86 limbs) patients suffered PTS received endovascular related surgery at the two institutions. The lesions were summarized into two categories: sufficient or insufficient inflow according to digital subtraction angiography(DSA). 77 limbs (89.53%) underwent successful endovascular treatment including 46 limbs receiving percutaneous transluminal angioplasty (PTA) and stent implantation ,and 31 limbs undergoing PTA without stent deployment was mainly contributed to insufficient inflow. The mean follow-up time was 23.44±16.91 months (range, 6-60 months) in stent implantation cohort. In-stent restenosis and an occlusive endograft edge were observed in two cases, respectively. No other stent-related complications, such as fractures or migration, were noted in any patient during the follow-up period.
Conclusions: Endovascular technique was safe and effective for the treatment of PTS and showed promising long-term prognosis. The novel classification of PTS might be feasible for the strategy of endovascular treatment.
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