Vascular and endovascular surgery最新文献

Superior vena cava syndrome is rare and challenging clinical entity in neonates. Medical treatment options are usually effective. However, when failed, surgery is warranted. Herein, we present a preterm neonate with SVC syndrome and associated chylothorax. When 2 weeks old, he underwent successful open thrombectomy and SVC reconstruction under cardiopulmonary bypass. Immediately after the operation findings of SVC syndrome and chylotorax were completely resolved. To our knowledge, this patient is the smallest baby underwent open SVC reconstruction with cardiopulmonary bypass.

Loeys-Dietz syndrome is a rare genetically triggered disease characterized by aortic involvement, predisposing individuals to aneurysm and dissection at young age. Open repair is considered the treatment of choice despite the fact that it is associated with significant morbidity and mortality rates. On the other hand, endovascular treatment may be also considered an acceptable option in specific cases such as emergency or in patients unfit for open surgery or when landing zones are within surgical grafts. We report the case of a thoracoabdominal aortic aneurysm (TAAA) open surgical repair (OSR) in a 22-year-old male patient diagnosed with type 2 Loeys-Dietz syndrome, treated by means of a TAAA replacement with a 30-mm multi-branched "Coselli" aortic graft (Vascutek, Renfrewshire, Scotland, UK) after multiple previously interventions, including a thoracic endovascular aortic repair (TEVAR) and a custom made endograft for the visceral aorta.

Background: To evaluate the feasibility, success rate, and safety of endovascular revascularization of patients with vertebral artery stump syndrome (VASS).

Methods: This single-center retrospective study analyzed clinical and imaging data from consecutive patients with VASS who underwent endovascular recanalization from January 2020 until June 2023.

Results: Our study enrolled 30 patients [mean age 69 (range 51-84) years; 26 men]. The rate of successful technical revascularization was 96.7% (n = 29), and the rate of complications was 3.3% (n = 1). At the 6-month follow-up, the patients with successful endovascular revascularization of VASS did not have any neurological symptoms, and computed tomography angiography showed 3/29 (10.3%) re-occlusions and 4/29 (13.8%) restenosis of the stent, which was confirmed by digital subtraction angiography.

Conclusions: Endovascular recanalization in patients with VASS is feasible in selected patients and has a high procedural success rate and low rate of complications. A large, multicenter, randomized study is warranted to confirm these findings.

Renal arteriovenous malformations (AVM) represent an uncommon vascular condition characterized by an abnormal direct communication between an intrarenal artery and vein. Though asymptomatic in many individuals, treatment is often indicated if the AVM causes flank pain, hematuria, or medically refractory hypertension, or if there is an associated renal artery aneurysm. We present a case of a large right renal AVM with associated renal artery aneurysm and large varix which was incidentally found on magnetic resonance imaging of the spine. Endovascular and open surgical options were considered, including ex-vivo renal vascular reconstruction and nephrectomy. The patient was successfully treated with endovascular embolization of the AVM with coil packing of the arterial aneurysm and inflow artery. The patient recovered uneventfully with well-maintained renal function and blood pressure control. We review and discuss the literature on the etiology and treatment options for renal AVM.

Objective: Management of limb ischemia in the setting of malignancy with history of resection and/or radiation presents a unique challenge. Radiation arteritis contributing to limb ischemia may not respond to endovascular intervention. Furthermore, significant tissue scarring from extensive resection and/or radiation can increase the risk of complications with open intervention and limit revascularization options. Utilization of an axillary to popliteal artery bypass using a lateral approach to the popliteal artery has been described as a reasonable alternative in these challenging cases.

Case report: The patient is a 68-year-old male with history of liposarcoma of the left groin, scrotum, and medial thigh for which he underwent multiple resections, flap reconstruction, and skin graft. He had a recurrence 2 years later and underwent repeat resection, placement of brachytherapy catheters, vertical rectus abdominal flap, and external beam radiation. He now presents with Rutherford 2B acute limb ischemia with associated left foot drop. Computed tomography angiography was performed and revealed an occluded left common femoral artery stent, proximal left superficial and deep femoral artery occlusion, and thrombosis of the left femoral vein. An attempt was made at endovascular recanalization without success. He subsequently underwent left axillary-to-lateral above knee popliteal artery bypass with a 6 mm ringed polytetrafluoroethylene graft, tibial thrombectomy, and 4 compartment fasciotomy.

Results: Post-operatively, his pain resolved. He continued to have left foot drop but recovered his ability to ambulate with a walker. He was ultimately discharged on post-operative day 11 to an inpatient rehabilitation facility on aspirin and apixaban.

Conclusion: Hostile groin secondary to infection, malignancy requiring resection/radiation presents a unique challenge for revascularization. When endovascular revascularization or obturator bypass are not feasible options, axillary-to-lateral above knee popliteal artery bypass is a described, feasible alternative approach to restore blood flow in this challenging patient population.

Background: Abdominal aortic aneurysms and atheromatous plaques are well-established potential culprits in the development of cholesterol embolization. This embolic phenomenon can result in the occlusion of peripheral arteries in the forefoot or toes, commonly referred to as "trash foot".

Case: A 61-year old patient exhibited severe symptoms and signs of lower limb and mesenteric ischemia, represented clinically by abdominal pain, hematochezia, and bilateral plantar necrotic lesions, attributed to embolization from a previously unknown large infrarenal abdominal aortic aneurysm. Diagnosis was confirmed by performing angio-CT of the abdomen, an angiologic examination, as well as colonoscopy. The patient underwent open surgical repair of the aortic aneurysm and received intravenous prostanoids, resulting in a successful outcome with resolution of bowel ischemia and complete recovery of bilateral foot lesions with no tissue loss.

Conclusion: Cholesterol embolization syndrome seldom manifests with its complete clinical spectrum. Identifying and addressing the underlying cause is crucial, with a focus on potential abdominal aortic aneurysms. A combined approach involving surgical repair and prostanoid therapy may offer a viable option for patients experiencing severe manifestations.

Purpose: To report a case of an asymptomatic patient with a pulmonary aneurysmal arterio-venous malformation successfully treated with a vascular plug.

Case report: An active 30-year-old male patient, residing at 3000 ft above sea level was referred due to an incidental finding on a CT scan of a 37 mm vascular mass localized in the lower lobe of the right lung, which corresponded to a pulmonary arteriovenous malformation with a single feeding artery. The patient was treated with an Amplatzer vascular plug, which effectively excluded the afferent vessel. An angio CT at 19 months follow-up revealed a hypodense residual mass of 9.0 mm in diameter with no arterial filling or venous drainage. The patient is fully active and remains asymptomatic at 24 months follow-up.

Conclusion: An unusual case of a pulmonary aneurysmal arteriovenous malformation successfully treated with a vascular plug is presented, highlighting the efficiency of this procedure.

Background: This study aims to determine the efficacy and safety of preoperative embolization in the management of Shamblin type III carotid body tumors (CBT).

Method: In this retrospective study, patients with Shamblin type III CBT were included between January 2005 and January 2017. A total of 48 Patients were divided into preoperative embolization (SRE, n = 25) and non-preoperative embolization group (SR, n = 23).

Result: Mean surgical time (145.24 ± 19.86 min vs 186.91 ± 17.808 min, P < 0.05) and intraoperative blood loss (271.4 ± 73.001 mL vs 380.36 ± 39.822 mL, P < 0.05) were markedly reduced in the SRE group compared with SR group. The preoperative tumor volume in the SRE group was larger than that in the SR group, but the volume was similar between the two groups after surgery. The number of tumor residual cases was higher in the SR group. The incidence of complications and duration of hospitalization were comparable between the two groups.

Conclusion: This study demonstrates the efficacy of preoperative embolization in reducing the duration of surgery and volume of blood loss during the process of CBT resection. More prospective, well-designed studies are urgently needed to validate the current findings.

Purpose: To compare the safety and efficacy of mechanical thrombectomy (MT) and ultrasound-accelerated thrombolysis (USAT) in pulmonary embolism (PE) management by performing a systematic review of the literature.

Materials and methods: The PubMed database was searched to identify articles on Inari's FlowTriever and Penumbra's Indigo mechanical thrombectomy devices (Group A) and the Ekos Endovascular system (Group B). Outcomes variables analyzed include pre- and post-procedure RV/LV ratio, pre- and post-procedure pulmonary artery pressure, hospital length of stay, technical success, specific complications, and mortality rate. Mean values were calculated using the weighted mean approach. RevMan Version 5.4 (Cochrane Collaboration) was used to perform the meta-analysis for this study. Cochrane Collaboration's Risk of Bias (RoB 2.0) approach was used to perform a quality assessment of the included articles in order to verify the validity and reliability of the research.

Results: 27 studies were in Group A and 28 studies pertained to Group B. There were 1662 patients in Group A and 1273 patients in Group B. Both groups had similar technical success (99.6% vs 99.4%). Thrombectomy showed longer mean procedure time (73.03 ± 14.57 min vs 47.35 ± 3.15 min), lower mean blood loss (325.20 ± 69.15 mL vs 423.05 ± 64.95 mL), shorter mean ICU stay (2.35 ± 1.64 days vs 3.22 ± 1.27 days), and shorter mean overall hospital stay (6.94 ± 4.38 days vs 7.23 ± 2.31 days). EKOS showed greater mean change in Miller Index (9.05 ± 3.35 vs 4.91 ± 3.70) and greater mean change in pulmonary artery pressure (14.17 ± 6.35 mmHg vs 8.11 ± 4.39 mmHg).

Conclusion: Ultrasound accelerated thrombolysis and percutaneous mechanical thrombectomy are effective therapies for pulmonary embolism with comparable clinical outcomes.

Background: Carotid body tumor (CBT) is a rare neoplasm that arises from the chemoreceptor cells located at the carotid bifurcation. Giant CBTs are extremely rare, with only 16 cases reported to date.

Case summary: A 63-year-old male with an unremarkable medical history presented with a right-sided, giant, Shamblin III CBT. For 20 years, he had been suffering from progressive dyspnea, dysphonia, and pain with left neck rotation. A computed tomography scan confirmed its dimension of 89 × 61 × 60 mm (height × width × depth). We performed our routine retrocarotid dissection technique (RCDT) without preoperative embolization. Histopathology reported an encapsulated, non-epithelial neuroendocrine neoplasm with architectural Zellballen pattern. His postoperative period was uneventful and was discharged home on day 2. At 5 years, he remains symptom-free without neoplasm recurrence.

Conclusion: This case illustrates the atypical clinical presentation and the successful treatment of a giant, Shamblin III CBT with the RCDT without preoperative embolization.