Vascular and endovascular surgery最新文献

PurposeLong-term survival after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains a clinical concern, particularly in elderly patients with comorbidities. This study aimed to compare different machine learning (ML) models that capture complex, nonlinear relationships among clinical variables to predict 5-year all-cause mortality following EVAR.MethodsWe retrospectively analyzed 142 patients who underwent elective EVAR between 2013 and 2018. Predictive models for 5-year mortality were developed using 3 supervised ML algorithms: Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Classification (SVC). Each model was trained on the entire dataset and internally validated through 5-fold cross-validation. Model performance was evaluated using accuracy, sensitivity, specificity, precision, F1 score, and area under the curve (AUC) based on the training set and 5-fold cross-validation. Feature importance was assessed for RF and XGBoost.ResultsThe RF demonstrated the most consistent performance (training AUC 0.80; cross-validation AUC 0.77 ± 0.07). XGBoost achieved the highest training accuracy (0.85) but had lower cross-validation AUC (0.68 ± 0.05). SVC showed stable but modest performance. Key predictors identified by RF and XGBoost included poor nutritional status, octogenarian status, compromised immunity, and active cancer.ConclusionsTree-based ML models, especially RF, may effectively predict long-term survival after EVAR. Incorporating key clinical predictors into preoperative assessment may enhance risk stratification. Future studies should explore external validation and integration with time-to-event models such as Cox proportional hazards, to enhance prognostic accuracy.

IntroductionAcute aortic occlusion (AAO) is a rare, life-threatening condition presenting with severe ischemia and requiring urgent intervention. While traditional open surgical approaches, including aortobifemoral and axillobifemoral bypasses, are well-established, endovascular techniques such as Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) have emerged as promising alternatives in select cases. This case introduces a novel modification termed Lysis Assisted CERAB (LA CERAB), combining thrombolysis and CERAB to manage acute graft occlusions.MethodsSingle-institution case report highlighting the utility of the LA CERAB technique in select patients.ResultsA 67-year-old male presented two years post-open aortobiiliac aneurysm repair with acute abdominal pain and bilateral limb ischemia without motor impairment. Initial CTA demonstrated complete thrombosis of his graft. He underwent percutaneous bilateral transfemoral catheter-directed thrombolysis. Post-thrombolysis angiography showed graft patency but significant residual thrombus. Subsequent LA CERAB successfully re-lined the graft, secured residual thrombus, and restored perfusion. The patient had an uneventful recovery, discharged home on therapeutic anticoagulation. Follow-up CTA at 2 months demonstrated sustained graft patency. This case highlights its applicability to acute presentations and adds to a growing body of literature on acute aortic graft occlusion interventions.ConclusionThe LA CERAB technique can serve as a novel, minimally invasive approach for select AAO patients presenting with high morbidity risks for transition open surgery. This case underscores patient-specific considerations in treatment strategy selection, illustrating how individualized surgical approaches can achieve favorable immediate and sustained clinical outcomes for future patients.

Background: Patients with abdominal aortic aneurysms (AAA) often have comorbidities that make them poor candidates for open surgical repair (OSR). Endovascular aortic aneurysm repair (EVAR) circumvents the morbidity associated with OSR of AAA. Candidacy for EVAR is impacted by multiple factors, including the quality and size of vascular access vessels and involvement of visceral arteries, as seen in paravisceral abdominal aortic aneurysms (PVAAA). Additional challenges, such as obesity, can complicate vascular access during EVAR. PVAAA may be better suited for fenestrated EVAR (FEVAR) using a physician-modified endograft (PMEG).Materials and Methods: In this report, we describe the case of a 64-year-old female patient with a complex PVAAA in the setting of significant aortoiliac occlusive disease (AIOD) with intermittent claudication. We describe a successful staged FEVAR technique in which vascular access challenges were first addressed by recanalization of the iliac system with femoral conduit (FC) creation, followed by successful FEVAR using bilateral FC for deployment of the PMEG.Conclusion: Patients with PAAA have unique and complex pathology that are clinically challenging to address. It is not uncommon that these patients also have co-morbid conditions that make them less-than ideal candidates for open repair. Patients may also have other conditions such as AIOD which make EVAR complex. Staged approach with iliac recanalization and femoral conduit creation followed by FEVAR with PMEG is an effective treatment option for high-risk complex patients and can help avoid common complications such as groin infection and delay in FEVAR which may result in a catastrophic event such as interval AAA rupture.

BackgroundVaricose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This study systematically reviews the effectiveness and safety of various anticoagulant strategies.MethodsA comprehensive literature search was conducted across PubMed, Embase, EBSCO, and Web of Science databases to identify relevant studies. Eligible studies were screened and selected based on predefined inclusion and exclusion criteria. A network meta-analysis was performed to compare different anticoagulant agents and prophylaxis durations indirectly. Additionally, a random-effects meta-analysis was conducted to calculate the relative risk (RR) and 95% confidence intervals (CI) for VTE and bleeding outcomes.ResultsA total of 11 studies, including 7359 patients who underwent either endovenous or open surgical procedures for varicose veins, met the inclusion criteria. Meta-analysis results indicated that pharmacological thromboprophylaxis was associated with a lower risk of VTE compared to no prophylaxis (RR = 0.49, 95% CI: 0.12-1.99, P < 0.01); however, this difference was not statistically significant. Similarly, there was no significant difference in bleeding risk between patients who received anticoagulant prophylaxis and those who did not (RR = 2.03, 95% CI: 0.82-5.07, P = 0.81). Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration.

BackgroundRetroperitoneal tumors represent a variety of rare lesions that can arise either from solid organs (kidney, pancreas, adrenals) or less commonly the mesenchymal soft tissue. Depending on histologic subtype, these malignancies often have a variable clinical presentation and prognosis.Case presentationIn the current series, we present 2 cases: first, a patient with Stage 3 retroperitoneal sarcoma eroding the para-visceral aorta causing rupture; second, a kidney transplant recipient with non-Hodgkin's lymphoma presenting as a ruptured right hypogastric arterial aneurysm.ConclusionWe discuss the caveats and pitfalls in diagnosing and treating these complex tumors including clinical and radiographic presentation.

BackgroundCarotid endarterectomy (CEA) remains the standard surgical intervention for carotid stenosis. While the conventional CEA (cCEA) and eversion techniques have been widely investigated, data on the clinical implications of modified eversion CEA (meCEA), which employs a limited arteriotomy of the carotid bulb, remain scarce. This study aimed to compare the early and mid-term outcomes of meCEA with those of cCEA using adjusted analyses.MethodsIn this retrospective study, 206 patients who underwent CEA between 2015 and 2025 at Daegu Catholic University Hospital were included. Patients were divided into the cCEA (n = 170) and meCEA (n = 36) groups. Baseline characteristics, operative profiles, and postoperative complications were compared using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to adjust for potential confounding. Overall survival (OS) and event-free survival (EFS) were evaluated using IPTW-adjusted Kaplan-Meier and Cox proportional hazards models.ResultsThe meCEA group showed marked intraoperative advantages, including a significantly lower rate of patch angioplasty (25.0% vs 87.1%), shorter operative time (94.3 ± 24.5 vs 139.8 ± 43.7 min), and reduced internal carotid artery clamp time (35.0 ± 12.7 vs 48.5 ± 12.5 min; all P < 0.001). No significant differences were observed in postoperative stroke, transient ischemic attack, or in-hospital mortality after PSM adjustment. IPTW-adjusted survival analysis revealed no statistically significant differences in OS (HR: 1.09, 95% CI: 0.38-3.14, P = 0.87) or EFS (HR: 1.29, 95% CI: 0.52-3.23, P = 0.581) between the groups. However, interpretation of long-term outcomes was limited by a shorter follow-up duration in the meCEA group (22.7 vs 63.9 months).ConclusionsThe meCEA technique offers significant operative benefits while demonstrating comparable early and mid-term safety profiles to conventional CEA. Although no significant survival difference was observed after adjustment, the results suggest that meCEA may serve as an effective alternative to cCEA. Further prospective studies with longer follow-up are needed to validate these findings.

IntroductionFirst-generation hydrogel coils have been shown to reduce the risk of recanalization due to their expansion properties. However, their clinical use has been limited by coil stiffness and time constraints for deployment. Recently developed second-generation hydrogel coils are softer and offer improved deliverability. This study aimed to evaluate their feasibility and effectiveness in transcatheter arterial embolization (TAE) for acute arterial bleeding in the body trunk.MethodsThis retrospective study included 24 TAE procedures performed in 23 patients (15 men, 8 women; median age, 72 years; range, 14-88 years) between March 2019 and November 2024. Indications for TAE included iatrogenic injury (n = 7), gastrointestinal bleeding (n = 5), trauma (n = 3), aneurysm rupture (n = 3), tumor invasion (n = 3), and others (n = 3). Second-generation hydrogel coils were used in all cases, comprising a median of 78% (range, 13-100%) of the total coil length. Technical success was defined as complete occlusion of the target artery on digital subtraction angiography. Clinical success was defined as the absence of rebleeding within 24 h of embolization.ResultsAnemia, hemorrhagic shock, and coagulopathy were present before TAE in 92% (22/24), 21% (5/24), and 25% (6/24) of procedures, respectively. The mean total coil length was 40 cm (range, 4-127 cm), and the mean procedure time was 111 min (range, 58-207 min). Both technical and clinical success rates were 100% (24/24). One complication (4%) occurred: transient liver dysfunction in a patient treated for hepatic artery bleeding.ConclusionsTAE using second-generation hydrogel coils showed high technical and clinical success rates, indicating that these coils may be a feasible and effective option for managing acute arterial hemorrhage in the body trunk.

ObjectivesEndovascular treatment (EVT) of lower extremity artery disease (LEAD) is minimally invasive and has good safety and efficacy. Puncture site complications are common in EVT, but these and the hemostatic time have been reduced by newer hemostatic devices such as ExoSeal. However, factors affecting poor outcomes after use of ExoSeal are unclear. Therefore, the purpose of this study is to identify these factors after ExoSeal deployment in EVT.Material and MethodsA retrospective study was performed for 868 cases in which hemostasis was attempted using ExoSeal between 2019 and 2023. Factors affecting deployment failure and prolonged hemostatic time after ExoSeal were assessed.ResultsThe 868 subjects (569 males, 66%) had a median age of 77 [72-83] years. A femoral antegrade approach was used in 548 cases (63%), with use of a 6Fr sheath in most cases (99%). The lesions were in the femoropopliteal (n = 387, 44%) and infrapopliteal (n = 359, 41%) arteries. The technical success rate of EVT was 97%. ExoSeal was successfully deployed in 812 cases (94%). Cases in which ExoSeal deployment was unsuccessful had significantly more frequent proximal stenting (9% vs 20%, P = .01). In the entire cohort, there were 6 (.69%) puncture site complications. Of the 812 cases with successful deployment, the manual compression hemostasis time was prolonged (>10 min) in 51 cases (6%). Hemostatic time was significantly prolonged in cases with proximal stenting or intimal thickening at the puncture site (both, P < .001).ConclusionThese results show that ExoSeal is a useful device. However, deployment failure and prolonged hemostatic time were caused by a proximal stent or intimal thickening of the puncture site, and use of hemostatic devices in such cases requires further investigation.

Purpose: This case highlights a rare and unique sequela following a popliteal artery aneurysm (PAA) rupture. The development of thigh compartment syndrome with haemodynamic instability as a consequence is exceptionally rare, as PAA rupture typically face resistance to rapid haemodynamic instability due to surrounding musculofascial and bony structures. To date, only 1 other published case report has documented a similar sequence of events.Case Summary: An 81-year-old male with a history of ischaemic heart disease, atrial fibrillation, and type 2 diabetes mellitus, but a lifelong non-smoker, presented in significant hemodynamic compromise due to a ruptured PAA. On examination, the affected extremity was swollen and tense, with sensory deficits distal to the knee, absent power in the hallux and ankle, and a faint dorsalis pedis pulse, but without evidence of acute distal ischemia. Computed tomography angiography (CTA) revealed a peripherally calcified ruptured right PAA, measuring 64 × 44 mm, accompanied by a substantial hematoma surrounding the aneurysm within the posterior thigh compartment. The patient underwent urgent endovascular repair followed by fasciotomies to manage the rupture and prevent further complications.Conclusion: This case demonstrates endovascular repair with a covered stent as a safe and effective alternative to open surgery in high-risk, unstable patients, allowing rapid aneurysm exclusion, limb salvage, and hemodynamic stabilisation. The patient provided informed consent for treatment and for the use of his clinical information in this case report.

PurposeTo assess the evidence in the current literature, identify the knowledge gaps and propose future standards for the use of pressure indices in peripheral arterial disease (PAD).MethodsA search of all medical databases was performed to identify studies performed between 01/01/2000 and 31/12/2024, looking at the use of FFR or IFR in the management of PAD. The Newcastle-Ottawa scale was used to assess the quality of the papers. A comparison of the studies was performed using various parameters including; study design, cohort demographics, aim, lesions treated, hyperaemic agent used/pressure indices utilised, FFR endpoint and clinical outcomes.Results136 studies were found in initial search. Only studies investigating FFR were identified, none looked at IFR. Following the application of the exclusion criteria, 8 relevant studies with a total of 247 patients were included in the final analyses. No randomised controlled or prospective trials were found. Significant heterogeneity was observed in the methodology and data collection among the included papers. Despite this, the analysis demonstrated initial evidence showing the potential of pressure measurements to revolutionise diagnostic, intra-procedural and prognostic decisions in PAD, akin to the data that already exists in coronary artery disease.ConclusionsFurther standardised research of FFR is needed in peripheral vascular disease to improve objective understanding of physiological parameters pre and post-treatment. To this end, a standardisation tool has been proposed to homogenise and aid future research in drawing more robust conclusions for the use of pressure indices in PAD.