Pub Date : 2025-01-01Epub Date: 2024-09-05DOI: 10.1177/15385744241279113
Kristopher Maier, Alex Helkin, Jeffrey J Stein, Helen L Yuan, Keri Seymour, Boris Ryabtsev, Chinenye Iwuchukwu, Vivian Gahtan
Introduction: Vascular smooth muscle cells are important in intimal hyperplasia. Thrombospondin-1 is a matricellular protein involved in the vascular injury response. Statins are cholesterol lowering drugs that have beneficial cardiovascular effects. Statis have been shown to inhibit smooth muscle migration through the mevalonate pathway. This effect is thought to be mediated by small G protein Ras and Rho turnover which requires many hours. While many patients undergoing treatment for vascular disease are on statins, many are not. Thus immediate pretreatment with statins before surgery may be beneficial. We hypothesized that statins have effects independent of the mevalonate pathway and thus have an immediate effect.
Methods: Human vascular smooth muscle cells were pretreated for 20 h (long-term) or 20 min (short-term) with fluvastatin, or mevalonolactone plus fluvastatin. Thrombospondin-1-induced migration, activation of p42/p44 extracellular signal-regulated kinase, c-Src, focal adhesion kinase and PI3 kinase was determined. The effect of fluvastatin on thrombospondin-1-induced expression of THBS1, FOS, HAS2 and TGFB2 was examined.
Results: Both treatments inhibited thrombospondin-1-induced chemotaxis back to the control group. Mevalonolactone reversed the long-term statin effect by increasing migration but had no effect on the short-term statin response. p42/p44 extracellular signal-regulated kinase was activated by thrombospondin-1 and both treatments augmented activation. Neither treatment affected c-Src activity, but both inhibited focal adhesion kinase and PI3 kinase activity. Only long-term statin treatment inhibited THBS1 expression while both treatments inhibited FOS and TGFB2 expression. Neither treatment affected HAS2. FOS knockdown inhibited thrombospondin-1-induced HAS2 but not TGFβ2 gene expression.
Conclusion: Long-term fluvastatin inhibited thrombospondin-1-induced chemotaxis through the mevalonate pathway while short-term fluvastatin inhibited chemotaxis through an alternate mechanism. Short-term stains have immediate effects independent of the mevalonate pathway. Acute local treatment with statins followed by longer term therapy may limit the vascular response to injury.
{"title":"Short-Term and Long-Term Fluvastatin Inhibit Effects of Thrombospondin-1 on Human Vascular Smooth Muscle Cells.","authors":"Kristopher Maier, Alex Helkin, Jeffrey J Stein, Helen L Yuan, Keri Seymour, Boris Ryabtsev, Chinenye Iwuchukwu, Vivian Gahtan","doi":"10.1177/15385744241279113","DOIUrl":"10.1177/15385744241279113","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular smooth muscle cells are important in intimal hyperplasia. Thrombospondin-1 is a matricellular protein involved in the vascular injury response. Statins are cholesterol lowering drugs that have beneficial cardiovascular effects. Statis have been shown to inhibit smooth muscle migration through the mevalonate pathway. This effect is thought to be mediated by small G protein Ras and Rho turnover which requires many hours. While many patients undergoing treatment for vascular disease are on statins, many are not. Thus immediate pretreatment with statins before surgery may be beneficial. We hypothesized that statins have effects independent of the mevalonate pathway and thus have an immediate effect.</p><p><strong>Methods: </strong>Human vascular smooth muscle cells were pretreated for 20 h (long-term) or 20 min (short-term) with fluvastatin, or mevalonolactone plus fluvastatin. Thrombospondin-1-induced migration, activation of p42/p44 extracellular signal-regulated kinase, c-Src, focal adhesion kinase and PI3 kinase was determined. The effect of fluvastatin on thrombospondin-1-induced expression of <i>THBS1</i>, <i>FOS</i>, <i>HAS2</i> and <i>TGFB2</i> was examined.</p><p><strong>Results: </strong>Both treatments inhibited thrombospondin-1-induced chemotaxis back to the control group. Mevalonolactone reversed the long-term statin effect by increasing migration but had no effect on the short-term statin response. p42/p44 extracellular signal-regulated kinase was activated by thrombospondin-1 and both treatments augmented activation. Neither treatment affected c-Src activity, but both inhibited focal adhesion kinase and PI3 kinase activity. Only long-term statin treatment inhibited <i>THBS1</i> expression while both treatments inhibited <i>FOS</i> and <i>TGFB2</i> expression. Neither treatment affected <i>HAS2</i>. <i>FOS</i> knockdown inhibited thrombospondin-1-induced <i>HAS2</i> but not <i>TGFβ2</i> gene expression.</p><p><strong>Conclusion: </strong>Long-term fluvastatin inhibited thrombospondin-1-induced chemotaxis through the mevalonate pathway while short-term fluvastatin inhibited chemotaxis through an alternate mechanism. Short-term stains have immediate effects independent of the mevalonate pathway. Acute local treatment with statins followed by longer term therapy may limit the vascular response to injury.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1177/15385744241298984
Sapna Puppala, Costa Tingirides, James Forsyth
Background: With increasing use of imaging to diagnose human pathology, newer aortic anomalies are being identified. An intra-aortic cord is one such abnormality, which requires differentiating from an intimal flap of dissection, to avoid major surgery or prolonged surveillance. The aim of this study was to bring forth a unique feature of the intra-aortic cord on imaging, using volume rendering reformatting and identify similar findings in published literature and hence establish the role of the 'Dimple' sign.
Methods: Review of both our institutional imaging (2 cases) as well as the published literature (6 cases), to identify presence of a diagnostic sign that is seen on volume rendered imaging of aorta.
Results: The 'Dimple sign' is unique to the intra-aortic cord and is noted on the images of 4 out of 6 prior publications. Two publications did not use volume rendering. Including our cases, the Dimple' sign is seen in 6 out of 8 cases. The Dimple sign arises due to tethering of the cord to the aortic wall leading to umbilication of the aortic wall inwards.
Conclusions: The Dimple sign can be very easily noted on volume and/or cinematic rendering and is a useful sign to diagnose an intra-aortic cord and help differentiate it from an intimal flap.
{"title":"The 'DIMPLE SIGN' of Intra-Aortic Cord.","authors":"Sapna Puppala, Costa Tingirides, James Forsyth","doi":"10.1177/15385744241298984","DOIUrl":"https://doi.org/10.1177/15385744241298984","url":null,"abstract":"<p><strong>Background: </strong>With increasing use of imaging to diagnose human pathology, newer aortic anomalies are being identified. An intra-aortic cord is one such abnormality, which requires differentiating from an intimal flap of dissection, to avoid major surgery or prolonged surveillance. The aim of this study was to bring forth a unique feature of the intra-aortic cord on imaging, using volume rendering reformatting and identify similar findings in published literature and hence establish the role of the 'Dimple' sign.</p><p><strong>Methods: </strong>Review of both our institutional imaging (2 cases) as well as the published literature (6 cases), to identify presence of a diagnostic sign that is seen on volume rendered imaging of aorta.</p><p><strong>Results: </strong>The 'Dimple sign' is unique to the intra-aortic cord and is noted on the images of 4 out of 6 prior publications. Two publications did not use volume rendering. Including our cases, the Dimple' sign is seen in 6 out of 8 cases. The Dimple sign arises due to tethering of the cord to the aortic wall leading to umbilication of the aortic wall inwards.</p><p><strong>Conclusions: </strong>The Dimple sign can be very easily noted on volume and/or cinematic rendering and is a useful sign to diagnose an intra-aortic cord and help differentiate it from an intimal flap.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and aggressive mesenchymal tumor, with less than 400 reported cases to date. Complete resection of the tumor with clear margins is the only proven curative treatment, providing survival benefits. Nonetheless, leiomyosarcomas in the middle segment or those extending up to it within the inferior vena cava (IVC) frequently necessitate renal reimplantation or nephrectomy, with rates varying between 56% and 75%. In this case report, we present a 65-year-old female with lower segment IVC leiomyosarcoma with middle segment extension, successfully resected and reconstructed while avoiding associated renal reimplantation or nephrectomy morbidity.
{"title":"Resecting Lower Segment Inferior Vena Cava Leiomyosarcoma With Middle Segment Extension While Avoiding Renal Morbidity.","authors":"Naveen Kumar Kushwaha, Pradeep Jaiswal, Vijay Pratap Singh, Pawan Kumar Dhaman","doi":"10.1177/15385744241276607","DOIUrl":"10.1177/15385744241276607","url":null,"abstract":"<p><p>Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and aggressive mesenchymal tumor, with less than 400 reported cases to date. Complete resection of the tumor with clear margins is the only proven curative treatment, providing survival benefits. Nonetheless, leiomyosarcomas in the middle segment or those extending up to it within the inferior vena cava (IVC) frequently necessitate renal reimplantation or nephrectomy, with rates varying between 56% and 75%. In this case report, we present a 65-year-old female with lower segment IVC leiomyosarcoma with middle segment extension, successfully resected and reconstructed while avoiding associated renal reimplantation or nephrectomy morbidity.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Residual dissection is a concern in endovascular treatment with a DCB, and there is limited knowledge of hemodynamics at a dissection lesion. Therefore, the objective of this study is to evaluate the mean pressure gradient (MPG) and fractional flow reserve (FFR) at a residual dissection after DCB angioplasty for the superficial femoral artery (SFA).
Methods: A total of 59 cases with residual SFA dissection treated with DCB angioplasty at a single center were analyzed retrospectively. The dissection was classified into 6 types (A-F). The primary endpoints were MPG and FFR at a residual dissection lesion after DCB angioplasty, using evaluation with a pressure wire.
Results: The median lesion length was 70 (40-130) mm with 24% popliteal involvement, and 11 cases (18%) had chronic total occlusion. A completion angiogram revealed dissection of types A (n = 33, 56%), B (n = 18, 31%), C (n = 7, 12%), and D (n = 1, 2%). The median MPGs in type A, B, and C cases were 0 (0-2), 0 (0-4), and 3 (0-6) mmHg, with a significant lower in type C cases than in type A cases (A vs C, P = .021). The median FFRs in type A, B, and C cases of 1.0 (.98-1.00), 1.0 (.96-1.00), and .98 (.95-1.00) did not differ significantly among dissection types (A vs B, P = .86; A vs C, P = .055; B vs C, P = .15).
Conclusions: This is the first report of hemodynamics at a SFA dissection. The results suggest that low-grade dissection (types A or B) does not affect MPG and FFR at a SFA lesion. This indicates that a bailout stent may be unnecessary for patients with dissection of types A or B. A further investigation is needed to determine whether a scaffold is required for a SFA lesion with type C dissection.
目的:使用 DCB 进行血管内治疗时,残余夹层是一个令人担忧的问题,而人们对夹层病变处的血液动力学了解有限。因此,本研究旨在评估股浅动脉(SFA)DCB血管成形术后残余夹层处的平均压力梯度(MPG)和分数血流储备(FFR):回顾性分析了在一个中心接受DCB血管成形术治疗的59例股浅动脉夹层残留病例。夹层分为 6 种类型(A-F)。主要终点是DCB血管成形术后残余夹层病变处的MPG和FFR,使用压线进行评估:中位病变长度为 70(40-130)毫米,24% 的病变累及腘窝,11 例(18%)为慢性全闭塞。完成血管造影显示,夹层类型为 A 型(33 例,56%)、B 型(18 例,31%)、C 型(7 例,12%)和 D 型(1 例,2%)。A、B和C型病例的中位MPG分别为0(0-2)、0(0-4)和3(0-6)mmHg,C型病例明显低于A型病例(A vs C,P = .021)。A、B和C型病例的中位FFR分别为1.0(.98-1.00)、1.0(.96-1.00)和.98(.95-1.00),不同夹层类型的FFR没有显著差异(A vs B,P = .86;A vs C,P = .055;B vs C,P = .15):结论:这是第一份关于SFA夹层血液动力学的报告。结果表明,低级别夹层(A 型或 B 型)不会影响 SFA 病变处的 MPG 和 FFR。这表明 A 型或 B 型夹层患者可能不需要救助支架。
{"title":"Mean Pressure Gradient and Fractional Flow Reserve at A Superficial Femoral Artery Dissection after Drug-Coated Balloon Angioplasty.","authors":"Taira Kobayashi, Takashi Fujiwara, Masaki Hamamoto, Takanobu Okazaki, Ryo Okusako, Tomokazu Yamaguchi, Naohide Sugawara, Mayu Tomota, Shinya Takahashi","doi":"10.1177/15385744241275055","DOIUrl":"10.1177/15385744241275055","url":null,"abstract":"<p><strong>Objectives: </strong>Residual dissection is a concern in endovascular treatment with a DCB, and there is limited knowledge of hemodynamics at a dissection lesion. Therefore, the objective of this study is to evaluate the mean pressure gradient (MPG) and fractional flow reserve (FFR) at a residual dissection after DCB angioplasty for the superficial femoral artery (SFA).</p><p><strong>Methods: </strong>A total of 59 cases with residual SFA dissection treated with DCB angioplasty at a single center were analyzed retrospectively. The dissection was classified into 6 types (A-F). The primary endpoints were MPG and FFR at a residual dissection lesion after DCB angioplasty, using evaluation with a pressure wire.</p><p><strong>Results: </strong>The median lesion length was 70 (40-130) mm with 24% popliteal involvement, and 11 cases (18%) had chronic total occlusion. A completion angiogram revealed dissection of types A (n = 33, 56%), B (n = 18, 31%), C (n = 7, 12%), and D (n = 1, 2%). The median MPGs in type A, B, and C cases were 0 (0-2), 0 (0-4), and 3 (0-6) mmHg, with a significant lower in type C cases than in type A cases (A vs C, <i>P</i> = .021). The median FFRs in type A, B, and C cases of 1.0 (.98-1.00), 1.0 (.96-1.00), and .98 (.95-1.00) did not differ significantly among dissection types (A vs B, <i>P</i> = .86; A vs C, <i>P</i> = .055; B vs C, <i>P</i> = .15).</p><p><strong>Conclusions: </strong>This is the first report of hemodynamics at a SFA dissection. The results suggest that low-grade dissection (types A or B) does not affect MPG and FFR at a SFA lesion. This indicates that a bailout stent may be unnecessary for patients with dissection of types A or B. A further investigation is needed to determine whether a scaffold is required for a SFA lesion with type C dissection.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-19DOI: 10.1177/15385744241273434
Georgios S Sfyroeras, Eleni Georgiadi, Georgia Papavasileiou, Stavros Spiliopoulos, John D Kakisis
Endovascular stent grafting is becoming more common in treating complex thoracic aortic aneurysms and dissections. When it becomes necessary to cover the supra-aortic vessels, maintaining blood supply through the supra-aortic branches can be achieved by performing in situ needle fenestration. We present a case of a 65-year-old man with a type B aortic dissection that extended from the origin of the left subclavian artery. A stent graft was inserted into the thoracic aorta distally of the origin of the left common carotid artery. Due to the stent graft moving distally and not adequately sealing the subclavian artery, a second stent graft was placed more proximally. Both stent grafts were successfully in situ fenestrated using a needle, and a stent graft was inserted into the subclavian artery. In conclusion, during thoracic endovascular aortic repair, in situ needle fenestration can be successfully carried out on two overlapping thoracic stent grafts.
在治疗复杂的胸主动脉瘤和动脉夹层时,血管内支架移植术越来越常见。当有必要覆盖主动脉上血管时,可以通过原位针孔穿刺来维持主动脉上分支的血液供应。我们介绍了一例 65 岁男子的病例,他患有 B 型主动脉夹层,并从左锁骨下动脉起源处延伸。在左侧颈总动脉起源远端将支架移植物插入胸主动脉。由于支架移植物向远端移动,不能充分封闭锁骨下动脉,因此在更近端放置了第二个支架移植物。用一根针成功地在原位将两块支架移植物撑开,并将支架移植物插入锁骨下动脉。总之,在胸腔内血管主动脉修复过程中,可以成功地在两个重叠的胸腔支架移植物上进行原位针穿刺。
{"title":"In Situ Needle Fenestration during Thoracic Endovascular Aneurysm Repair: Successful Fenestration of Two Overlapping Thoracic Stent Grafts.","authors":"Georgios S Sfyroeras, Eleni Georgiadi, Georgia Papavasileiou, Stavros Spiliopoulos, John D Kakisis","doi":"10.1177/15385744241273434","DOIUrl":"10.1177/15385744241273434","url":null,"abstract":"<p><p>Endovascular stent grafting is becoming more common in treating complex thoracic aortic aneurysms and dissections. When it becomes necessary to cover the supra-aortic vessels, maintaining blood supply through the supra-aortic branches can be achieved by performing in situ needle fenestration. We present a case of a 65-year-old man with a type B aortic dissection that extended from the origin of the left subclavian artery. A stent graft was inserted into the thoracic aorta distally of the origin of the left common carotid artery. Due to the stent graft moving distally and not adequately sealing the subclavian artery, a second stent graft was placed more proximally. Both stent grafts were successfully in situ fenestrated using a needle, and a stent graft was inserted into the subclavian artery. In conclusion, during thoracic endovascular aortic repair, in situ needle fenestration can be successfully carried out on two overlapping thoracic stent grafts.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-21DOI: 10.1177/15385744241265750
Keohane Cr, Westby D, Twyford M, Aherne T, Tawfick W, Walsh Sr
Introduction: Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested.
Methods: We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible.
Results: 98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, P = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences.
Conclusion: The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation.Trial registered at clinicaltrials.gov NCT04484168.
{"title":"Axial Ablation versus Terminal Interruption of the Reflux Source (AAVTIRS): A Randomised Controlled Trial.","authors":"Keohane Cr, Westby D, Twyford M, Aherne T, Tawfick W, Walsh Sr","doi":"10.1177/15385744241265750","DOIUrl":"10.1177/15385744241265750","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested.</p><p><strong>Methods: </strong>We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible.</p><p><strong>Results: </strong>98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, <i>P</i> = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences.</p><p><strong>Conclusion: </strong>The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation.Trial registered at clinicaltrials.gov NCT04484168.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-22DOI: 10.1177/15385744241276688
Sifut Sethi, Jakub Michalski, Rand Moh'd Elayyan Al-Shboul, Frank Carey, Kelvin Tan, Tariq Ali
Introduction: Our retrospective study aimed at assessing safety of vascular closure devices (VCDs) used in a large single-centre Interventional Radiology (IR) department. Complication and deployment failure rates using collagen-based (Angio-seal) and suture-based (ProGlide) devices for common femoral artery haemostasis were compared.
Materials and methods: Data from VCDs deployed over a 6-year period were retrospectively analysed for patient age, procedure indication, puncture mode (antegrade/retrograde), sheath size, deployment failure and complications (haematoma, pseudoaneurysm formation, limb occlusion). Numerical and statistical analysis was undertaken.
Results: Overall, 1321 common femoral artery punctures in 1217 patients were closed using VCDs. Failure rate using ProGlide was significantly higher when compared with Angio-seal (P=<0.001) in sheath sizes ≤8 Fr. Heparin was not administered in embolisation procedures compared with angioplasty with or without stenting. Therefore, haematoma tended to occur more frequently following angioplasty without stenting (P = 0.003) and angioplasty with stenting (P = 0.001), when compared with embolisation. Deployment failure occurred more frequently when heparin was used during the procedure (P = 0.005).
Conclusion: Although complications relating to sheath size are well established in the literature, there remains a paucity of data assessing the impact of procedure specific factors when comparing VCDs. Our study challenges that size is the sole determinant of VCD success and invites a more holistic view of VCD deployment strategies. This study advocates continued research into the nuances of other potential confounding variables to optimise patient outcomes.
{"title":"Procedure-Related Complication Rates With the Use of Vascular Closure Devices; Does Size Only Matter? A Large Single Centre Retrospective Study.","authors":"Sifut Sethi, Jakub Michalski, Rand Moh'd Elayyan Al-Shboul, Frank Carey, Kelvin Tan, Tariq Ali","doi":"10.1177/15385744241276688","DOIUrl":"10.1177/15385744241276688","url":null,"abstract":"<p><strong>Introduction: </strong>Our retrospective study aimed at assessing safety of vascular closure devices (VCDs) used in a large single-centre Interventional Radiology (IR) department. Complication and deployment failure rates using collagen-based (Angio-seal) and suture-based (ProGlide) devices for common femoral artery haemostasis were compared.</p><p><strong>Materials and methods: </strong>Data from VCDs deployed over a 6-year period were retrospectively analysed for patient age, procedure indication, puncture mode (antegrade/retrograde), sheath size, deployment failure and complications (haematoma, pseudoaneurysm formation, limb occlusion). Numerical and statistical analysis was undertaken.</p><p><strong>Results: </strong>Overall, 1321 common femoral artery punctures in 1217 patients were closed using VCDs. Failure rate using ProGlide was significantly higher when compared with Angio-seal (<i>P</i>=<0.001) in sheath sizes ≤8 Fr. Heparin was not administered in embolisation procedures compared with angioplasty with or without stenting. Therefore, haematoma tended to occur more frequently following angioplasty without stenting (<i>P</i> = 0.003) and angioplasty with stenting (<i>P</i> = 0.001), when compared with embolisation. Deployment failure occurred more frequently when heparin was used during the procedure (<i>P</i> = 0.005).</p><p><strong>Conclusion: </strong>Although complications relating to sheath size are well established in the literature, there remains a paucity of data assessing the impact of procedure specific factors when comparing VCDs. Our study challenges that size is the sole determinant of VCD success and invites a more holistic view of VCD deployment strategies. This study advocates continued research into the nuances of other potential confounding variables to optimise patient outcomes.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-22DOI: 10.1177/15385744241276615
George Elzawy, Paul Petrasek, Ali Fatehi Hassanabad
Acute limb ischemia (ALI) is the sudden onset of decreased blood supply to the extremities and carries a poor prognosis for the affected limb and survival. A rare but well-recognized embolic etiology is a paradoxical embolism, the translocation of a thrombus from venous to arterial circulation through an intracardiac communication, most commonly a patent foramen ovale. The presentation of ALI secondary to a PFO-mediated paradoxical embolism is most often accompanied by combinations of deep vein thrombosis (DVT), pulmonary embolism (PE), and an acute cerebral or visceral ischemia. We present the first documented case of a Rutherford class I ALI secondary to a PFO-mediated paradoxical embolism, ipsilateral DVT, and PE in a 29-year-old female who was surgically managed for her disabling claudication rather than limb salvage. The overlapping presentation of a viable ALI and ipsilateral DVT created a challenging clinical diagnosis. Our review of the literature on PFO-mediated paradoxical emboli involved 43 reports including 51 patients with various arterial thromboses; 19 of these cases involved lower extremity ALI. This case report is the first case to date that demonstrates a paradoxical embolism causing acute lower extremity ischemia with ipsilateral DVT and no additional limb/visceral ischemia to suggest the diagnosis of ALI. We also highlight the role that quality of life plays in vascular surgical decision-making, extending ALI management goals to not only reducing mortality and major amputations, but also improving quality of life.
急性肢体缺血(ALI)是指突然发生的肢体供血减少,患肢预后不良,存活率低。一种罕见但公认的栓塞病因是矛盾性栓塞,即血栓通过心内沟通(最常见的是卵圆孔)从静脉循环转移到动脉循环。继发于 PFO 媒介的矛盾性栓塞的 ALI 通常伴有深静脉血栓形成 (DVT)、肺栓塞 (PE) 以及急性脑或内脏缺血。我们介绍了首例记录在案的卢瑟福I级ALI病例,患者是一名29岁的女性,因PFO介导的矛盾性栓塞、同侧深静脉血栓形成和肺栓塞而继发ALI。存活的 ALI 和同侧深静脉血栓的重叠表现给临床诊断带来了挑战。我们查阅了有关PFO介导的矛盾性栓塞的43篇文献,包括51例各种动脉血栓患者,其中19例涉及下肢ALI。本病例报告是迄今为止第一例显示矛盾性栓塞导致急性下肢缺血,同时伴有同侧深静脉血栓形成,但没有其他肢体/内脏缺血的病例,因此不能诊断为 ALI。我们还强调了生活质量在血管外科决策中的作用,将 ALI 的治疗目标扩展到不仅降低死亡率和主要截肢率,而且提高生活质量。
{"title":"The Unique Case of Acute Limb Ischemia in a Patient With a Patent Foramen Ovale.","authors":"George Elzawy, Paul Petrasek, Ali Fatehi Hassanabad","doi":"10.1177/15385744241276615","DOIUrl":"10.1177/15385744241276615","url":null,"abstract":"<p><p>Acute limb ischemia (ALI) is the sudden onset of decreased blood supply to the extremities and carries a poor prognosis for the affected limb and survival. A rare but well-recognized embolic etiology is a paradoxical embolism, the translocation of a thrombus from venous to arterial circulation through an intracardiac communication, most commonly a patent foramen ovale. The presentation of ALI secondary to a PFO-mediated paradoxical embolism is most often accompanied by combinations of deep vein thrombosis (DVT), pulmonary embolism (PE), and an acute cerebral or visceral ischemia. We present the first documented case of a Rutherford class I ALI secondary to a PFO-mediated paradoxical embolism, ipsilateral DVT, and PE in a 29-year-old female who was surgically managed for her disabling claudication rather than limb salvage. The overlapping presentation of a viable ALI and ipsilateral DVT created a challenging clinical diagnosis. Our review of the literature on PFO-mediated paradoxical emboli involved 43 reports including 51 patients with various arterial thromboses; 19 of these cases involved lower extremity ALI. This case report is the first case to date that demonstrates a paradoxical embolism causing acute lower extremity ischemia with ipsilateral DVT and no additional limb/visceral ischemia to suggest the diagnosis of ALI. We also highlight the role that quality of life plays in vascular surgical decision-making, extending ALI management goals to not only reducing mortality and major amputations, but also improving quality of life.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-22DOI: 10.1177/15385744241274267
Ki Yoon Moon, Eun Ju Jang, Seung Hoon Lee, Hong Suk Han, Sun Cheol Park, Jang Yong Kim, Sang Seob Yun
Introduction: Currently, there are two types of percutaneous arteriovenous fistula (pAVF) formation systems approved by the FDA: Ellipsys and WavelinQ. Although these systems are already in use in Europe or the United States, they have not been approved for use in Korea yet. For this reason, this study aimed to check anatomical feasibility of these systems for Korean population prior to their actual use.
Methods: Consecutive patients who received ultrasound vein mapping for arteriovenous fistula formation from June 2021 to June 2022 were included. The anatomical feasibility of each system was confirmed according to the manufacturer's instructions for use (IFU).
Results: Upper extremity ultrasonography was performed for a total of 83 patients to determine their feasibility for pAVF formation. Of these patients, 65.1% were feasible for pAVF formation with appropriate deep communicating vein (DCV) and outflow. Among them, 57.8% were feasible for the Ellipsys system and 54.2% were feasible for the WavelinQ system. Most patients who were infeasible for pAVF formation had a DCV of small size. Ulnar vessels were more suitable than radial vessel for WavelinQ (54.2% vs 33.7%, P-value = .012). The most common reason for not meeting the criteria was a small vein size at the access site.
Conclusions: More than half of all patients were feasible for pAVF formation in this study. Ellipsys had a higher feasibility than WavelinQ, although they showed no significant difference in the feasibility. If these devices are imported into Korea, it will be a good opportunity for many patients to reduce the surgical burden and create AVFs more easily through these procedures.
{"title":"Anatomical Feasibility of Percutaneous Arteriovenous Fistula Formation in Korea.","authors":"Ki Yoon Moon, Eun Ju Jang, Seung Hoon Lee, Hong Suk Han, Sun Cheol Park, Jang Yong Kim, Sang Seob Yun","doi":"10.1177/15385744241274267","DOIUrl":"10.1177/15385744241274267","url":null,"abstract":"<p><strong>Introduction: </strong>Currently, there are two types of percutaneous arteriovenous fistula (pAVF) formation systems approved by the FDA: Ellipsys and WavelinQ. Although these systems are already in use in Europe or the United States, they have not been approved for use in Korea yet. For this reason, this study aimed to check anatomical feasibility of these systems for Korean population prior to their actual use.</p><p><strong>Methods: </strong>Consecutive patients who received ultrasound vein mapping for arteriovenous fistula formation from June 2021 to June 2022 were included. The anatomical feasibility of each system was confirmed according to the manufacturer's instructions for use (IFU).</p><p><strong>Results: </strong>Upper extremity ultrasonography was performed for a total of 83 patients to determine their feasibility for pAVF formation. Of these patients, 65.1% were feasible for pAVF formation with appropriate deep communicating vein (DCV) and outflow. Among them, 57.8% were feasible for the Ellipsys system and 54.2% were feasible for the WavelinQ system. Most patients who were infeasible for pAVF formation had a DCV of small size. Ulnar vessels were more suitable than radial vessel for WavelinQ (54.2% vs 33.7%, <i>P</i>-value = .012). The most common reason for not meeting the criteria was a small vein size at the access site.</p><p><strong>Conclusions: </strong>More than half of all patients were feasible for pAVF formation in this study. Ellipsys had a higher feasibility than WavelinQ, although they showed no significant difference in the feasibility. If these devices are imported into Korea, it will be a good opportunity for many patients to reduce the surgical burden and create AVFs more easily through these procedures.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-20DOI: 10.1177/15385744241276644
Ari Ettleson, Justin Robbins, Enrico Ascher, Anil Hingorani
Retropharyngeal internal carotid artery (ICA) is a rare, yet well-described anatomical variant that poses significant challenges to the management of carotid artery stenosis. In this case report, we discuss the treatment of symptomatic ICA stenosis with a retropharyngeal ICA using the transcarotid artery revascularization (TCAR) technique. A 70-year-old female with comorbidities presented with neurological symptoms and severe ICA stenosis. After diagnostic evaluation, TCAR was chosen for surgical intervention. The patient did well postoperatively. This case emphasizes the importance of considering TCAR when treating ICA stenosis in patients with anatomic variation of ICA location. It also supports adding anatomic variants such as retropharyngeal ICA to the list of indications for TCAR.
{"title":"Transcarotid Artery Revascularization for Symptomatic Retropharyngeal Internal Carotid Artery Stenosis.","authors":"Ari Ettleson, Justin Robbins, Enrico Ascher, Anil Hingorani","doi":"10.1177/15385744241276644","DOIUrl":"10.1177/15385744241276644","url":null,"abstract":"<p><p>Retropharyngeal internal carotid artery (ICA) is a rare, yet well-described anatomical variant that poses significant challenges to the management of carotid artery stenosis. In this case report, we discuss the treatment of symptomatic ICA stenosis with a retropharyngeal ICA using the transcarotid artery revascularization (TCAR) technique. A 70-year-old female with comorbidities presented with neurological symptoms and severe ICA stenosis. After diagnostic evaluation, TCAR was chosen for surgical intervention. The patient did well postoperatively. This case emphasizes the importance of considering TCAR when treating ICA stenosis in patients with anatomic variation of ICA location. It also supports adding anatomic variants such as retropharyngeal ICA to the list of indications for TCAR.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}