Vascular and endovascular surgery最新文献

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.

Background: Chronic limb-threatening ischemia (CLTI) leads to decreased quality of life and increased disease burden, resulting in progressive patient deterioration, limb amputation, and mortality.

Objectives: This study aims to present the outcomes of a Latin American experience using the open distal venous arterialization (DVA) technique for no-option limb salvage in a high volume CLTI center.

Methods: A retrospective case series study was performed including patients from 2018 to 2022 using a population from Bogotá, Colombia. Patients with no-option chronic limb-threatening ischemia underwent open DVA with a 12 month follow-up period. Variables such as operative time, hospital and ICU length of stay, graft material, re-interventions, 1-year patency, amputations and 1-year mortality were recorded.

Results: 5 patients with a mean age of 71 years were intervened. 60% were male and 80% had a diabetes mellitus diagnosis. Four patients underwent a reverse great saphenous vein graft procedure and 1 composite polytetrafluoroethylene graft. A total of 80% of patients demonstrated graft patency after 1 year. No perioperative mortalities were recorded but one late postoperative mortality due to myocardial infarction occurred. One major amputation was required, minor amputations were performed in 2 of the patients.

Conclusion: Open DVA is a feasible low cost technique for adequately selected patients with favorable saphenous vein, as evidenced by the limb salvage and graft patency outcomes.

Loeys Dietz Syndrome (LDS) is an autosomal dominant connective tissue disorder resulting from a mutation in the transforming growth factor beta receptor (TGFBR) family of genes. It is commonly associated with the development of aortic aneurysms and dissections. We report the successful open surgical management of thoracoabdominal aneurysms in a father and daughter with Loeys-Dietz Syndrome after failed endovascular repair. The daughter required stent graft explantation, while the stent graft remained in the father. These cases highlight the importance of early genetic testing of both patients and first-degree family members in those with a strong history of aortic disease, even when there is a lack of typical connective tissue disorder associated physical exam findings and open surgical index operations.

Cardiac myxomas are the most common primary benign tumors of the heart. The occlusion of peripheral arteries and complete obstruction of the abdominal aorta by a tumor embolus presents with distinct clinical manifestations. Herein, we present the case of a 38-year-old male with acute paresthesia, muscle weakness, erythematous, and violaceous changes in skin color localized to the dorsum of the left forefoot initially treated as cutaneous vasculitis. Further studies revealed the total occlusion of the terminal abdominal aorta by a saddle embolus from a cardiac myxoma. A multidisciplinary team consisting of cardiothoracic and vascular surgeons were involved in treating the patient, which resulted in full resolution of the case. This paper details the progression of acute bilateral limb ischemia to chronic limb threatening ischemia resulting from the total occlusion of the terminal abdominal aorta by a saddle embolus.

Background: Stanford Type A Aortic Dissection (TAAD) is associated with high in-hospital mortality and the need for immediate surgical intervention. Larger hospital size may be associated with better patient care and surgical outcomes. This study aimed to examine the effect of hospital size on TAAD outcomes.

Method: Patients who underwent TAAD repair were identified in National Inpatient Sample (NIS) from Q4 2015-2020. NIS stratifies hospital size into small, medium, and large based on the number of hospital beds, geographical location, and the teaching status of the hospitals. Patients admitted to small/medium and large hospitals were stratified into two cohorts. Multivariable logistic regressions were performed to compare in-hospital outcomes, adjusted for demographics, comorbidity, primary payer status, and hospital characteristics including procedural volume.

Results: There were 1106 and 3752 TAAD admitted to small/medium and large hospitals, respectively. Among patients admitted to small/medium hospitals, there was higher mortality (17.27% vs 14.37%, aOR = 1.32, P < 0.01), but shorter length of stay (P < 0.01) and lower cost (P = 0.03) compared to larger hospitals. There was no difference in morbidities.

Conclusions: Marked higher mortality is associated with admission to smaller hospitals among patients with TAAD, which may in turn decrease the average hospital stay and cost. Given that a significant percentage of patients are already being transferred out of the initial hospital and small/medium hospital is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.

Objective: Analysis of gender-specific differences in short- and long-term outcome after elective open abdominal aortic aneurysm repair (OAR) regarding the distal anastomosis.

Methods: In this retrospective cohort study, data from 4853 patients of a German health insurance company undergoing OAR for infrarenal abdominal aortic aneurysms (AAAs) between 2010 and 2016 were analysed. The patients were followed through 2018.

Results: A total of 4050 (83.5%) men and 803 (16.6%) women underwent OAR. Women were older than men (72.9 ± 8.7 vs 69.8 ± 8.5 years; P < .001). A tube graft was used in 2644 (54.5%) patients, an aorto-biiliac bifurcated graft in 1657 (34.1%) and an aorto-bifemoral bifurcated graft in 552 (11.4%). Perioperative mortality was not significantly different between men (5.7%) and women (6.5%) in the total patient population (P = .411). This was true for aorto-aortic tube grafting (P = .361), aorto-biiliac reconstructions (P = 1.000) and aorto-bifemoral reconstructions (P = .345). Kaplan-Meier estimated long-term survival of men after 9 years was better than that of women (55.0% vs 43.8%; P = .006). However, separated by the site of the distal anastomosis, this was only true for aorto-aortic reconstructions (survival men vs women 56.0% vs 42.1%; P = .005), not for aorto-biiliac and aorto-bifemoral reconstructions. In the multivariate Cox regression analysis, age over 80 years, heart failure, aorto-bifemoral reconstruction, chronic kidney disease stage 3-5, chronic obstructive pulmonary disease, peripheral artery disease, arterial hypertension, but not gender (P = .531), had a negative impact on long-term survival.

Conclusion: If possible, an aorto-aortic tube graft should be preferred to aorto-biiliac and aorto-bifemoral reconstructions in OAR. Patients selected for aorto-bifemoral artery reconstruction exhibit higher perioperative morbidity and mortality as well as worse long-term survival compared to patients selected for an intra-abdominal reconstruction. In the multivariate regression analysis, gender was not an independent risk factor for either short- or long-term outcomes.

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed. Diagnosis of popliteal vein entrapment can be done with duplex imaging with flexion and extension maneuvers; however, venography is the gold standard for diagnosis. While popliteal vein entrapment is commonly associated with younger individuals, it may also be an underdiagnosed condition in older patients. We describe two cases of successful diagnosis and treatment of late-onset presentation of popliteal vein entrapment.

Background: This case report describes a novel endovascular technique for treating superior mesenteric artery (SMA) occlusion, a condition leading to chronic mesenteric ischemia (CMI). Traditional treatment methods for CMI, primarily due to SMA stenosis, are often complex and risky, particularly for patients unsuitable for conventional surgery. Objective: This study details the application of retrograde recanalization followed by the deployment of a VIABAHN covered stent in a patient with complete SMA ostium occlusion. Methods: The procedure's success in re-establishing mesenteric blood flow demonstrates its potential as a less invasive, safer alternative to traditional surgical approaches. This technique's innovation lies in its retrograde approach, allowing for effective treatment in cases where antegrade access is unfeasible. Results: The patient showed significant symptom improvement without procedural complications, underscoring the method's efficacy and safety. Conclusion: These findings suggest that retrograde stent implantation can be a viable option for managing SMA occlusions, especially in high-risk surgical cases. The successful application of this technique in this case contributes to the evolving landscape of endovascular interventions in vascular surgery and offers a promising direction for future research and clinical practice in treating SMA-related conditions.

A 53 year old woman needed surgical management of an anastomotic pseudoaneurysm after renal transplant. Contrast enhanced computed tomography demonstrated a pseudoaneurysm arising off of the right external iliac artery. Considering the risk of potentially sacrificing her renal transplant, we elected to perform endovascular repair with parallel stent grafting. The operation was successful and postoperative course uneventful illustrating that this approach may be beneficial in similar circumstances.