Vascular and endovascular surgery最新文献

BackgroundIdentifying the aetiology of ischemic stroke can be challenging, especially when critical findings are overlooked. Stroke assessment often relies on standardised guidelines, primarily focused on carotid stenosis severity (>50%) as an intervention criterion. However, this approach may neglect high-risk plaque features. This case report highlights the importance of integrating diagnostic findings with clinical presentation to guide management.Case presentationA 68-year-old male presented with sudden-onset transient right arm weakness. Initial imaging, including MRI and CT angiography, revealed a subtle diffusion-weighted imaging (DWI) abnormality in the left hemisphere and moderate carotid atherosclerosis (<50%) that did not meet guideline criteria for endarterectomy. Despite antiplatelet and anticoagulant therapy, the patient experienced multiple recurrent ischemic episodes. Due to the persistence of symptoms, the multidisciplinary team (MDT) recommended advanced vessel wall MRI, which identified intraplaque haemorrhage and plaque ulcerations in the left internal carotid artery-critical findings missed on conventional imaging. This led to a decision to perform carotid endarterectomy. Histology confirmed atheromatous disease with intraplaque haemorrhage. Following surgery, the follow-up scans showed no new infarcts with no clinical recurrence.DiscussionThis case underscores the limitations of relying solely on carotid stenosis degree in stroke management and highlights the importance of identifying high-risk plaque characteristics. Advanced vessel wall imaging proved instrumental in guiding treatment, while MDT collaboration ensured a tailored approach. The findings emphasise the need to prioritise carotid stenosis characteristics over stenosis degree alone when guiding clinical decisions to optimise outcomes in ischemic stroke management.

BackgroundObstructive sleep apnea (OSA) is a recognized risk factor for aortic dissection development due to its association with arterial hypertension, negative intrathoracic pressures during respiratory efforts, and further development of aortic false lumen. However, the impact of OSA on the outcomes of type A aortic dissection (TAAD) repair has not been extensively investigated. Therefore, this study aimed to perform a population-based analysis of the impact of OSA on in-hospital outcomes following TAAD repair.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were employed to compare the in-hospital outcomes between patients with and without OSA, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status were adjusted for.ResultsThere were 465 (10.86%) and 3817 (89.14%) patients with and without OSA who underwent TAAD repair. Patients with and without OSA had comparable in-hospital mortality (9.89% vs 15.75%, aOR = 0.744, 95 CI = 0.535-1.035, P = .08). Patients with OSA had a higher risk of diaphragmatic paralysis (0.86% vs 0.21%, aOR = 4.821, 95 CI = 1.405-16.539, P = .01) but lower risks of pericardial complications (12.04% vs 19.02%, aOR = 0.675, 95 CI = 0.501-0.909, P = .01) and cardiogenic shock (11.40% vs 18.21%, aOR = 0.643, 95 CI = 0.472-0.875, P = .01). All other in-hospital outcomes were comparable.ConclusionWhile OSA is a known risk factor for the development of TAAD, it does not appear to significantly affect short-term surgical outcomes. Future research should focus on stratifying OSA by duration and severity and examining the long-term prognosis of these patients.

Background: Endovascular Aneurysm Repair (EVAR) is a proven, safe, and effective treatment; however, its application may be limited by the potential adverse effects of iodinated contrast medium (ICM), which can exacerbate renal function and may be contraindicated in patients with renal insufficiency. Purpose: This review aims to provide an overview of "zero-iodine contrast EVAR," which uses CO₂ exclusively, as a strategy to mitigate the risk of acute kidney injury (AKI) associated with ICM. Research design: A systematic literature review was conducted in PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify EVAR cases performed using carbon dioxide. The Medical Subject Headings (MeSH) terms used were "endovascular repair AND abdominal aortic aneurysm AND contrast medium" and "endovascular repair AND abdominal aortic aneurysm AND carbon dioxide," with inclusion criteria limited to articles in English published until December 2024. Results: The literature search yielded 1167 papers. After removing duplicates, titles and abstracts were screened, and 68 papers underwent full-text review. A total of 16 studies were included in the analysis, encompassing 1625 patients. Of these, 837 patients underwent EVAR with ICM, and 788 patients underwent EVAR with CO₂. Of these, 510 patients were treated with EVAR using CO₂ exclusively. Conclusions: Although this method still faces inherent limitations due to the physicochemical characteristics of CO₂, its use, when combined with additional technical precautions, enables the achievement of zero-contrast results in standard EVAR procedures.

ObjectiveThe purpose of this study was designed to assess the correlation between Life's Essential 8 (LE8) score and the risk of stroke in American adults using data from subjects of the NHANES.MethodsSubjects' data were obtained from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2020.The ..LE8 score integrates health behaviors as well as health factors. We employed weighted multivariate logistic regression models as well as propensity score matching methods to explore the relationship between these health behaviors, health factors, and LE8 scores and stroke risk. In addition, the restricted cubic spline (RCS) technique was used to examine possible nonlinear associations between these variables and stroke risk.ResultsA total of 31,653 subjects were included in this study, of whom 1187 (3.8%) had stroke. After considering all covariates, the results of weighted logistic regression modeling showed that subjects with intermediate cardiovascular health (CVH) levels had a significantly lower risk of stroke compared to subjects with low CVH levels(OR = 0.5,95%CI:0.41-0.61), while subjects with high CVH levels had a further reduced risk of stroke (OR = 0.29,95%CI:0.16-0.51). After propensity score matching, the results remain consistent with the above.RCS analysis showed a significant nonlinear correlation between LE8 score and stroke risk(P for nonlinear< 0.001). The results of the subgroup analyses were consistent across categories, indicating a significant negative association between LE8 and stroke.ConclusionAmong American adults, LE8 scores are negatively associated with stroke risk, which can be reduced through early screening and customized interventions for those with low CVH.

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.

IntroductionSurgical site infection (SSI) following transmetatarsal amputation (TMA) is thought to be common. In patients who have peripheral arterial disease (PAD) or diabetes related foot complications, little is known regarding the effectiveness of interventions designed to reduce SSI following TMA. Our aim was to perform a systematic review of the literature to inform practice and highlight areas that warrant further research to reduce SSI post TMA.MethodsThis review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and was prospectively registered with the International Prospective Register of Systematic Reviews (CRD4202454958). MEDLINE, EMBASE and Cochrane databases were searched using a predefined search strategy, without date restriction. All randomised controlled trials (RCTs) and observational studies including patients that underwent TMA due to PAD or complications of diabetes related foot disease, with at least 1 intervention designed to promote wound healing or reduce SSI were included. Bias was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.ResultsThe initial search identified 445 papers. Two RCTs and three observational studies, reporting on 378 TMAs and four interventions, were included. The effect of post-operative antibiotic use on the incidence of SSI differed between the studies. The use of antibiotic-impregnated beads embedded within the soft tissues prior to wound closure were associated with a reduction in SSI rate. The use of Negative Pressure Wound Therapy (NPWT) was associated with a reduction in SSI incidence and faster wound healing. No significant difference was identified in the incidence of SSI between different skin preparations.ConclusionData regarding interventions to prevent SSI following TMA are sparse in the current literature. Prolonged post-operative antibiotic use could reduce SSI, while NPWT and antibiotic beads may be beneficial to wound healing. However, larger more robust RCTs are required to confirm these findings.