Vascular and endovascular surgery最新文献

BackgroundChronic mesenteric ischemia (CMI) can result from progressive atherosclerotic disease with symptoms arising in severe cases. Endovascular revascularization with a balloon-expandable covered stent is the preferred first-line treatment for CMI, but balloon deployment may be complicated by severe calcification in the mesenteric arteries. Techniques used to address severe calcification, such as open surgery revascularization and high-pressure, non-compliant balloon dilations, are associated with higher complication rates and calcium fracturing. Intravascular lithotripsy (IVL) is a novel technique to treat arterial calcifications in situ, having previously been used to target atherosclerotic lesions in the coronary and peripheral arterial beds.Case PresentationWe present a 93-year old woman with a one year history of severe postprandial abdominal pain with an acute worsening of her mid-epigastric pain for two days. CTA showed severe calcifications at the origin of the superior mesenteric artery (SMA), which was confirmed and localized by an aortogram. Intravascular lithotripsy (IVL) was used to break down the calcification and prepare the SMA for stenting. Following IVL treatment, two overlapping covered stents were deployed and a final aortogram demonstrated patency of the SMA ostia with distal flow in the ileocecal branch.ConclusionIVL could be considered an adjunct to stenting in the setting of severe atherosclerotic disease in the visceral arteries when endovascular revascularization with stenting or balloon angioplasty is insufficient. Although IVL has been investigated in the treatment of calcifications in the coronary and peripheral arteries, it is necessary to explore IVL as a potential treatment for atherosclerotic lesions in the mesenteric arteries in a larger patient population.

BackgroundAdventitial cystic disease (ACD) of the popliteal artery is a rare cause of intermittent claudication, typically presenting as a focal lesion, with long-segment involvement being even more uncommon.Case SummaryA 53-year-old man presented with progressive left calf claudication for one year, worsening over the last 6 months. Imaging studies, including computed tomography and magnetic resonance imaging, identified a cystic lesion compressing the popliteal artery, with duplex ultrasound estimating its length at 6 cm. However, intraoperative findings revealed the lesion extended over 10 cm into the adductor hiatus. To achieve proximal control, adductor hiatus division was required. The cystic segment was resected, and a great saphenous vein interposition graft was placed. The patient recovered uneventfully with complete symptom resolution.ConclusionThis case highlights the feasibility of a posterior approach with adductor hiatus division for long-segment ACD, emphasizing the importance of thorough preoperative assessment and tailored surgical planning.

BackgroundThe treatment of hemodialysis access dysfunction include creating a new fistula, balloon dilation, or stent implantation. However, these options are not suitable for all patients. We adopted patch angioplasty to reconstruct the hemodialysis access and observed this group of cases to evaluate the feasibility, effectiveness, and safety of this surgical method.MethodsBetween 2021 and 2024, we performed 14 cases of patch angioplasty using PTFE patch material. We recorded the time of fistula establishment, time of patch angioplasty, surgical site, transitional dialysis status using central venous catheter, complications, and patency of the fistula in this group of cases.ResultsAll 14 patients successfully underwent patch angioplasty, with a technical success rate of 100%. During follow-up, 3 patients died respectively 2, 8, 9 months post-operation. The longest follow-up time was 38 months. The primary patency rates for target lesions were as follows: 92.3% at 3 months (12/13), 81.8% at 6 months (9/11), 77.8% at 12 months (7/9), and 57.1% at 24 months (4/7). The cumulative patency rates were: 3 months 100% (13/13), 6 months 90.9% (10/11), 12 months 88.9% (8/9), and 24 months 71.4% (5/7). No cases experienced infection, bleeding, pseudoaneurysm, or steal syndrome.ConclusionsPTFE patch angioplasty for hemodialysis access reconstruction yields a high technical success rate and serves as an effective solution after hemodialysis access dysfunction. It has high safety and good patency rates, making it a recommended method for access reconstruction.

PurposeTo describe a case of recurrent cerebral infarction caused by stenosis at the origin of the aberrant right subclavian artery and to discuss the technical advantages of a radial artery approach for stenting.MethodsA right radial artery approach with a balloon guiding catheter was used to perform stenting, under dual antiplatelet therapy. Distal protection was achieved through proximal balloon occlusion, enabling retrograde contrast visualization of the aortic arch and stenotic segment.ResultsSuccessful stent deployment was achieved with easy access, accurate vessel selection, and full visualization of the landing zone. No perioperative complications occurred, and postoperative CTA follow-up confirmed the absence of in-stent restenosis. The patient was transitioned to single antiplatelet therapy after six months.ConclusionThe radial artery approach with balloon-guided protection appears to be a safe and effective option for treating stenosis at the origin of an aberrant right subclavian artery.

IntroductionPedicle screw-related aortic injuries are rare but potentially life-threatening complications of spinal instrumentation. While some cases remain asymptomatic for extended periods, delayed recognition increases the risk of catastrophic vascular events. Early diagnosis and appropriate management are critical to prevent severe morbidity and mortality. Traditional open vascular repair carries significant risks, whereas thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive alternative. However, clear guidelines for diagnosis and treatment in spine surgery remain lacking.MethodsWe present 2 cases of aortic injury caused by pedicle screws following spinal instrumentation. Both patients underwent multidisciplinary management, including intravascular ultrasound (IVUS) for vascular assessment, TEVAR for aortic repair, and pedicle screw removal/repositioning. A review of the literature was conducted to contextualize these cases within existing management strategies.ResultsBoth patients were successfully treated with TEVAR and pedicle screw revision, without perioperative complications. IVUS played a crucial role in confirming the extent of vascular involvement and guiding intervention. At 18-month and 24-month follow-up, both patients remained asymptomatic, with no evidence of graft migration, endoleak, or spinal instability.ConclusionsPedicle screw-related aortic injuries, though uncommon, pose a serious risk in spine surgery. Multidisciplinary management involving spine and vascular surgery is essential for optimal outcomes. IVUS enhances diagnostic accuracy, allowing for precise treatment planning. Endovascular stent placement, combined with appropriate pedicle screw revision, is an effective and safe management strategy. Given the lack of standardized guidelines, we propose a structured decision-making approach for spine surgeons encountering vascular complications. Future research should focus on risk stratification, screening protocols, and long-term outcomes of endovascular management in spinal instrumentation.

ObjectiveTo evaluate the efficacy of a multimodal endovascular approach integrating excimer laser atherectomy (ELA), percutaneous transluminal angioplasty (PTA), and drug-eluting stent (DES) implantation for managing complex aortic occlusion in Takayasu arteritis (TA).MethodsA 24-year-old female with TA presented with progressively debilitating clinical manifestations, including severe hypertension (217/126 mmHg) and bilateral lower limb claudication that significantly impaired daily function despite medical management. Imaging confirmed a chronic infra-renal aortic occlusion. Given the lesion complexity and the patient's young age, a multidisciplinary team decision prioritized a minimally invasive approach to avoid the higher risks of open surgery. The selected strategy sequentially integrated ELA for controlled debulking of the fibrotic occlusion and DES implantation to mitigate long-term restenosis risk.ResultsAt 6-month follow-up, ankle-brachial indices improved bilaterally, with normalized systolic blood pressure and absence of claudication. Postoperative contrast-enhanced computed tomography angiography (CTA) confirmed sustained aortic artery patency without restenosis or collateral formation.ConclusionThis case demonstrates the feasibility of ELA and DES integration as a minimally invasive strategy for TA-related aortic lesions, achieving durable hemodynamic and clinical outcomes.

IntroductionWound healing complications (WHC) of groin incisions are frequently discussed in vascular surgery. Various preventive measures are often applied to reduce their rates, but not all have the desired effect, and all these measures have their respective costs. The main aim of this study is to determine the effectiveness of closed incision negative pressure therapy (ciNPT) in reducing WHCs in high-risk patients after major revascularization procedures compared to the conventional adhesive dressing and to investigate the cost-benefit of its routine use.Material and methodsFrom April 2023 to October 2024, 30 patients with 60 groin wounds who underwent aortic-bifemoral bypass surgery had their right groin wound treated with ciNPT and left groin wound with a conventional surgical adhesive dressing. The ciNPT system was removed after 7 days postoperatively. Both wounds were examined on the 7^th and 30^th postoperative day and any WHCs were marked and graded by the Szilagyi classification. Hospitalization costs and hospital stay periods of all patients were also analyzed.ResultsThe ciNPT-treated wound showed a statistically significant reduction in WHCs against the conventionally treated contralateral groin (P = 0.025). None of the ciNPT-treated wounds prolonged hospital stay and a significant increase in hospitalization costs (P < 0.001) has been observed in patients who developed WHCs, prolonging hospital stay (P = 0.007).ConclusionHigh-risk vascular surgery patients are very likely to benefit from ciNPT and the routine use of this method may also be considered economically, however, additional research must be conducted to evaluate indications better.

A 49-year-old female presented with subacute onset of severe worsening bilateral lower extremity swelling. Bilateral iliac venous thrombus and extensive thrombus of the inferior vena cava with extension to the right atrium and bilateral segmental pulmonary emboli was identified on imaging. She was initiated on therapeutic anticoagulation prior to undergoing percutaneous mechanical thrombectomy with the RevCore TM device (Inari Medical, Irvine, CA) with retrieval of white, relatively well-formed organized clot vs mass. Intravascular ultrasound and venography showed significant improvement in the IVC and iliac vein patency, but some narrowing of the vena cava. The patient's course was complicated by hypotension and acidemia requiring extracorporeal membrane oxygenation for seventy-two hours. She was taken back during her hospitalization for additional venogram and intravascular ultrasound with long segment IVC stenting of the IVC stenosis. She was ultimately discharged with significant clinical improvement. While the nitinol coring element on this device is meant for use in venous stent thrombus, this case demonstrates additional uses for the RevCoreTM device in organized thrombus in the native system in selective patients.

Traumatic venous injuries are associated with high mortality rates. When they involve the inferior vena cava and iliac veins, prompt treatment is necessary in cases of patient instability. Endovascular treatment of a traumatic injury at the iliac confluence extending to the proximal external iliac vein was performed in a 50-year-old patient following a fall. A GORE Excluder PLC141400 endograft was placed at the bleeding site via percutaneous transfemoral access, combined with simultaneous embolization of the internal iliac vein through right percutaneous jugular access. Effective haemostasis was achieved, along with normalization of blood pressure. Prompt diagnosis and recognition of the condition are vital for achieving blood pressure stabilization and haemostasis in unstable patients.

ObjectiveVascular closure devices (VCDs) are essential in modern neuro-interventional procedures, offering advantages over manual compression by accelerating hemostasis, reducing complications, and enabling early ambulation. The Obtura 8F VCD is a novel bioabsorbable closure device designed to enhance safety and procedural efficiency. This study evaluates its efficacy and safety in achieving hemostasis and preventing vascular complications following femoral artery access.MethodThis retrospective, single-center study analyzed patients who underwent femoral artery closure with the Obtura 8F VCD. The primary performance endpoint was a successful hemostasis without additional intervention. The primary safety endpoint was the incidence of vascular complications within 30 days and 3 months. Secondary outcomes included time to ambulation and length of hospital stay.ResultsA total of 100 patients (mean age: 59.48 ± 13.03 years, 64% male) were included. Hemostasis was successfully achieved in 96% of cases, and all patients were able to move the limb within 8 hours post-procedure. During hospitalization, hematoma/pseudoaneurysm occurred in 6% of patients, with age ≥65 years, hypertension, and diabetes identified as significant risk factors. No evidence of infection was reported at either 30 days or 3 months. The majority of patients (80%) were discharged within 4-7 days.ConclusionsThe Obtura 8F VCD demonstrated high efficacy in achieving hemostasis with a strong safety profile with no major vascular complications. These findings support its use as a reliable alternative to manual compression, facilitating faster patient recovery and potentially reducing hospital resource utilization.