Vascular and endovascular surgery最新文献

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.

BackgroundThe role of endovascular therapy for patients presenting with AMI continues to be debated. This study was undertaken to compare open and endovascular treatment of AMI.MethodsAll patients who presented with AMI between 2010 and 2022 were identified. Patient demographics, baseline laboratory studies, length of stay (LOS), and outcomes were recorded. Student's t-test was used for quantitative data and Fisher's exact test for qualitative data.ResultsSixty-five patients were treated for AMI: 47 with an open procedure; 18 with endovascular techniques. Of the 18 patients in the endovascular group, 8 (45%) underwent laparotomy/laparoscopy; four (22%) requiring bowel resection. Patients treated with an endovascular approach were more likely to be male (87% vs 45%, P = .025), be caused by thrombosis (78% vs 55%, P = .005), have lower incidence of other vascular disease (56% vs 87%, P = .015) and have a lower initial WBC (11.9 ± 3.9 vs 18.5 ± 8.4, P = .0017). There was shorter ICU LOS in the endovascular group (5.5 ± 5.7 vs 13.5 ± 13.8, P = .025). A trend for decreased bowel resection was seen in the endovascular group compared the open group [4 (22%) vs 19 (40%), P = .25]. A trend for lower mortality was seen in the endovascular group compared to the open group (22% vs 40%, P = .25). In the 23 patients that died, the cause of death was directly related to bowel ischemia in 16 (70%), cardiac in 5 (22%) and stroke in 2 (9%).ConclusionEndovascular treatment of AMI has potentially lower mortality and lengths of stay. When choosing endovascular vs open treatment, the status of the bowel should be an important initial determinate. We recommend that the underlying etiology (thrombosis vs embolic) also be a consideration with a low threshold for conversion to an open procedure if endovascular treatment does not rapidly restore mesenteric flow in patients with embolic disease.

Spontaneous recanalization (SR) of an internal carotid artery (ICA) is a rare phenomenon. Cases reported in literature described the evolution of dissection or atherothrombotic / cardioembolic acute occlusions. No case of post-endarterectomy ICA occlusion resolved by SR has never been reported. Herein, we describe the case of a 64-year old male patient who presented an ipsilateral ischemic stroke due to the ICA occlusion in the second post-operative day of a carotid endarterectomy (CEA) and SR 6 months later, without anticoagulant therapy administration. The aim of this report was to increase awareness of this unusual entity and to highlight the usefulness of duplex ultrasound (DUS) surveillance of ICA eventual postoperative occlusions in order to detect accidental recanalization and to propose an adjunctive treatment whenever needed.

ObjectiveTo evaluate the impact of introducing a surgeon-led emergency endovascular aneurysm repair (EVAR) service on patient outcomes and cost efficiency in the management of ruptured abdominal aortic aneurysms (rAAA) at a UK tertiary vascular center.MethodsA retrospective cohort study was conducted, including all patients presenting with rAAA between January 2019 and December 2023. Patients were categorized into two time periods: before (Period A: 2019-2020) and after (Period B: 2021-2023) the introduction of the emergency EVAR service. Outcomes assessed included 30-day and one-year mortality, length of hospital stay, complication rates, and return-to-theatre rates. Cost-effectiveness analysis was conducted using incremental cost-effectiveness ratio (ICER) calculations based on Quality-Adjusted Life Years (QALYs).ResultsA total of 71 patients with ruptured abdominal aortic aneurysm were identified, of whom 58 underwent surgical repair (OSR or EVAR). In Period A, all patients (n = 17) underwent open surgical repair. In Period B, 24 received OSR (58.5%) and 17 received EVAR (41.5%). The 30-day mortality rate was significantly lower in the EVAR group (5.9%) compared to OSR in both periods (63.3% and 50%, respectively; P = .001). The one-year mortality rate remained unchanged for EVAR but increased for OSR (P = .00075). Return-to-theatre rates were significantly higher in OSR patients (P = .044). ICER calculations showed EVAR to be cost-effective (-£202 526 per QALY within one year).ConclusionThe introduction of a surgeon-led emergency EVAR service significantly improved early survival rates and reduced reintervention rates in rAAA patients while demonstrating cost-effectiveness compared to OSR.

ObjectiveRestenosis limits the benefit of below-the-knee (BTK) endovascular therapy (EVT). Restenosis may be attributable to limited information from digital subtraction angiography. A promising alternative is intravascular ultrasound (IVUS). However, data regarding the association between post-EVT IVUS-detected lesions and the risk for future major adverse limb events (MALE) after BTK EVT are scarce.DesignProspective single-arm observational pilot study.MethodsPatients scheduled for BTK EVT were eligible. Altogether, 50 patients were included after informed consent. IVUS was performed in treated BTK vessels to analyze vessel characteristics and, if present, lesions. Lesions were defined as; significant stenoses (≥50%), substantial vessel wall irregularities (highly calcified multisided sharp wall irregularities without significant stenosis and over a longer track post-PTA), any dissections, and incorrect stenting. Follow-up included duplex ultrasound (DUS) after 3, 6 weeks, and 3 and 6 months after EVT by trained independent nurses blinded to IVUS findings. Primary endpoint was MALE, including restenosis/occlusions and major amputation.ResultsIn total, 33/50 (66%) participants had at least one lesion following IVUS. Compared to the group without any lesions, no difference in baseline characteristics was found. Lesions contained mostly significant stenosis (52%) or wall irregularities (20%). Within 6 months, 28 (56%) participants experienced MALE, including 23 restenosis/occlusion. In total, 21/28 (75%) participants with MALE had a lesion on IVUS imaging. Participants with MALE had a higher incidence of any lesions on IVUS compared with the no-lesion group (64% vs 41%), leading to a sensitivity of 0.75 and specificity of 0.45.ConclusionThis study suggests a good sensitivity for IVUS in detecting post-treatment lesions leading to MALE. However, a well-powered study is warranted to confirm these results. Ultimately, a randomized trial should assess the effect of interventions for IVUS-detected lesions post-EVT on reduction of risk of future MALE. However, the first needs are standardized reporting definitions, categorization of IVUS-detected lesions, and standardization of operating procedures.

Background: A pulmonary arteriovenous malformation (PAVM) is an abnormal connection between the pulmonary arterial and venous systems, resulting in a pathologic right-to-left shunt. PAVMs worsen during pregnancy due to physiologic changes, yet no treatment guidelines exist for newly diagnosed PAVMs in pregnancy.Case: We report a case of a previously asymptomatic 19-year-old G1 who was incidentally found to have a low oxygen saturation during routine prenatal care at 34 5/7 weeks of gestation. She was diagnosed with a complex, left-sided PAVM. Through the close collaboration of the interventional radiology and high-risk obstetric teams, antenatal embolization was successfully performed, allowing for the prolongation of pregnancy. The patient experienced spontaneous rupture of membranes at 36 1/7 weeks and underwent a successful Cesarean delivery at this time.Conclusion: Embolization of a complex PAVM in the third trimester of pregnancy was successfully and safely achieved by a skilled multidisciplinary team. In comparable clinical scenarios, clinicians should carefully assess maternal and fetal risks-such as neonatal prematurity, radiation exposure, and PAVM-related complications-to guide optimal management.

Aortic pleomorphic sarcomas are rare, aggressive vascular tumors often presenting with nonspecific symptoms that delay diagnosis. We describe a 53-year-old male who presented with isolated lower extremity claudication. Examination revealed absent pulses in the left leg, and duplex vascular ultrasound showed monophasic flow. CT angiography demonstrated a 48 mm infrarenal abdominal aortic aneurysm extending to the iliac bifurcation, a bulge in the left common iliac artery, and high-grade stenosis in a short segment. The patient underwent surgical repair with a Y-graft. Histopathological analysis confirmed undifferentiated pleomorphic sarcoma with a high Ki67 index (65%) and absence of specific immunohistochemical markers. Postoperative PET-CT revealed metastatic disease involving lungs, liver, and bones. The patient subsequently received systemic chemotherapy. This case highlights the diagnostic challenges of undifferentiated pleomorphic sarcoma when they present with isolated ischemic symptoms rather than signs of malignancy Early recognition through imaging and histopathology is essential, as surgical resection remains the cornerstone of treatment despite poor prognosis.

ObjectivesThoracic Endovascular Aortic Repair (TEVAR) is now the standard of care for management of aortic injury from trauma. Long term outcomes stratified by the severity of the aortic injury are limited.MethodsThis is a single center retrospective analysis of all patients undergoing TEVAR for trauma between January 2008-November 2023. Long term outcomes of mortality and re-intervention were stratified and compared based on the blunt thoracic aortic injury score. Kaplan Meier analysis was used to compute one year and 5-year survival.ResultsA total of 104 patients (age 42 ± 15 years; 72 males; 69%) underwent TEVAR for trauma. Most repairs were for grade 3 (59 patients, 57%) or grade 4 (30 patients, 29%) blunt aortic injuries. The remaining patients included grade 1 (1 patient, 1%), grade 2 (14 patients; 13%). Grade 4 injuries were not associated with higher rate of concomitant neurologic injuries (P = 0.33) or death (P = 0.74). Eighty-seven percent patients had a mean follow up of 4.2 ± 3.3 years. Two patients died due to aortic related causes within 30 days (intra-operative hemorrhage in one patient, graft collapse in one patient who had an unsuccessful exploratory thoracotomy). Overall, one year survival was 92%, and 5-year survival was 88% by Kaplan Meier analysis. Patients with neurologic injury trended toward higher mortality in Kaplan Meier analysis but this was not statistically significant (log rank = 0.22). The grade of injury was not significant for long term survival (log rank = 0.81). Early reintervention was required in 2% patients with none required in long-term. Age>40 (P = 0.17), female sex (P = 0.34) and graft diameter>26 mm (P = 0.41) were not significant for re-intervention. None of the patients experienced endoleaks or spinal cord ischemia.ConclusionsTEVAR is a durable repair for patients with BTAI requiring no re-intervention after one year follow-up. CT surveillance of TEVAR in setting of trauma should be limited to 1 and 5 years after surgery. Long term survival is not related to severity of BTAI.

BackgroundIn 2022, the United States Medical Licensing Examination (USMLE) Step 1 transitioned to a pass/fail format, removing a long-standing objective measure from residency applications. This shift led applicants and/or residency program directors to place increased emphasis on alternative metrics such as research output (RO), though how much programs value this remains unclear. This study explores RO trends among vascular surgery applicants from 2014-2024 and compares them by applicant type and across other competitive surgical specialties.MethodsNRMP Charting Outcomes in the Match reports (2014-2024) were reviewed. The mean number of abstracts, presentations, and peer-reviewed publications (RO) was collected for matched and unmatched U.S. MD seniors applying to vascular surgery. RO data for Doctor of Osteopathic Medicine (DO) and non-U.S. international medical graduate (IMG) applicants were also reviewed for completeness.ResultsRO among matched U.S. MD vascular surgery applicants rose by 54.7%, from 7.0 in 2014 to 12.8 in 2024. The most marked increase occurred between 2018 and 2022 (8.3 to 12.4; +67%), with growth plateauing thereafter after 2022. In contrast, RO among matched DO and IMG applicants declined: DO applicants dropped from 21.3 in 2022 to 9.0 in 2024, and IMG applicants from 60.3 in 2020 to 38.3 in 2024. However, 2024 sample sizes were small, 137 matched U.S. MDs vs only 3 DOs and 6 IMGs, limiting direct comparisons.ConclusionWhile RO among vascular surgery applicants surged after Step 1 became pass/fail, the recent plateau suggests a transient response rather than ongoing growth, differing from trends in other surgical subspecialties. These findings raise concerns about equity and added pressure on underrepresented applicants. Further research is needed to clarify RO's actual role in residency selection and inform fairer evaluation practices.