Vascular and endovascular surgery最新文献

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.

BackgroundFew single center studies with small sample size have been published showing clinical benefits of endovascular intervention specifically using mechanical suction thrombectomy for P.E. without systemic/catheter lytic therapy. This study will analyze our initial experience and clinical outcomes in the treatment of P.E. using Inari FlowTriever thrombectomy device.Patient Population/MethodsA single center retrospective study of 50 consecutive patients with acute P.E. were treated with the INARI FlowTriever device between January 2019 to June 2023. All patients were submassive P.E. with right ventricular strain (RV/LV ratio >0.9) and requiring oxygen therapy or having increase in oxygen therapy from baseline. Procedural and clinical success (Improvement in intraoperative pulmonary artery pressures and oxygen therapy) were evaluated along with in hospital procedural related complications with a mean follow up of 8 months (range 1-22.5 months).ResultsAll patients were stratified as intermediate high-risk PE with a mean age of 68 years. Right ventricular dilation was present in 100% of patients with a mean RV/LV ratio of 1.55 (range 0.9-2.7). Mean pre-op Troponin was 434 (median 318, range 6-2332) and mean BNP was 352 (median 154, range 60-1787). Procedural success as defined by SIR guidelines was achieved in 100% of patients. There was 0% hospital mortality, device related mortality, or complications including bleeding, and acute kidney injury (AKI). Significant improvement in FiO2 was noted when comparing the mean pre-procedural FiO2 of 40.6% (range of 21%-100%) to a mean of FiO2 of 28.3% (range of 21%-52%) at 24 h post procedure (P < .0001). Proportion of patients on room air increased from 0% pre procedure to 94% at 48 h. The mean pre-op pulmonary artery pressure improved from 47 mm Hg (range 20-74) to mean post pulmonary artery pressure of 34 mm Hg (range 19-65) P < .0001. 97% of patients had a decrease in their pre-op pulmonary pressures intraoperatively.In late follow-up when evaluating pre to post intervention 36/38 (94.4%) of our patients were back to baseline with regards to oxygen requirement. Proportion of patients on room air increased from 0% pre procedure to 94.4% post procedure. 34/38 (89%) of patients reported they were back to baseline in regard to physical activity and 37/38 (97%) of patients reported their breathing status was back to baseline from prior to procedure. Using the modified Medical Research Council Dyspnea Score, 93% of patients reported a pre-op score of four (highest) while 70% reported scores of zero (normal) and or score of one post intervention with 100% showing improvement at 8 month follow up.ConclusionOur study demonstrates both safety and effectiveness in using the INARI FlowTriever for patients with submassive acute pulmonary embolism.

Common carotid artery pseudoaneurysm is the formation of a hematoma outside the vessel wall resulting from a transmural rupture. Its causes include open or blunt trauma, infections, or previous surgical procedures. These lesions usually present with a wide range of symptoms due to mass effect, and the diagnosis relies on a high index of suspicion and imaging methods. Treatment remains controversial; however, surgical management-either open or endovascular-is generally preferred. This report presents the case of a 19-year-old patient with a history of gunshot wound in neck. Imaging revealed a pseudoaneurysm of the right common carotid artery, which was surgically treated through resection and interposition of an ePTFE graft. This article discusses the etiology, diagnosis, and treatment of post-traumatic carotid artery pseudoaneurysm, with the aim of increasing awareness of this condition and its clinical presentations, thereby promoting timely diagnosis and appropriate therapeutic intervention to prevent fatal outcomes.

Background: Heparin-induced thrombocytopenia (HIT) is an acquired prothrombotic state from anti-heparin platelet-factor 4 (PF4) mediated activation of platelets. Anti-PF4 assay is used to screen for HIT due to high sensitivity and negative predictive value. Case Report: We present a 74-year-old male that had clinical HIT with false negative anti-PF4 and subsequently positive serotonin release assay (SRA). Delay in cessation of heparin led to recurrent limb thrombosis in the setting of multiple revascularization attempts with a poor outcome. Conclusion: We re-emphasize the importance of clinical presentation in management of patients with suspected HIT.

BackgroundDual antiplatelet therapy (DAPT) is used peri-operatively as standard care for patients who undergo carotid artery stenting (CAS). Nonetheless, this regimen is associated with several problems, including ischemic complications due to antiplatelet resistance, as well as hemorrhagic complications. This study investigated the feasibility of single antiplatelet therapy (SAPT) with prasugrel for CAS.MethodsRecords of consecutive patients who underwent elective CAS between January 2015 and December 2024 were reviewed. Patients administered SAPT with prasugrel and those administered DAPT with aspirin and clopidogrel were compared. The P2Y12 reaction unit (PRU) was measured using VerifyNow System. Effectiveness and safety outcomes were defined as ischemic and hemorrhagic complications within 3 months of CAS.ResultsA total of 146 patients were included in this analysis. The absolute PRU value was significantly lower in the SAPT group than in the DAPT group (128.5 vs 163.0, P < 0.01). The rate of ischemic events within 3 months did not significantly differ (SAPT vs DAPT, 0.0% vs 3.7%, P = 0.53). The rate of hemorrhagic complications also showed no significant difference (SAPT vs DAPT, 5.3% vs 0.9%, P = 0.34). Four patients in the SAPT group and twelve patients in the DAPT group regularly took anticoagulants, and the rate of bleeding events did not significantly differ between them.ConclusionsPrasugrel ensured an adequately low PRU value compared with clopidogrel. SAPT with prasugrel may be an alternative to DAPT in patients undergoing CAS without increasing the risk of complications. This regimen may be used safely, even in patients who regularly use anticoagulants.

BackgroundDigital educational resources have transformed patient care as a powerful tool for clinicians to assist patients in their medical decision-making. However, a significant degree of online educational materials is unstandardized in terms of the quality, readability, and transparency of the information provided to patients. The objective of this study was to evaluate the accuracy, quality, and readability of publicly available digital patient education materials addressing patient questions on venous diseases and image-guided interventions.Materials and MethodsA cross-sectional study addressed the objective of this study by utilizing Rothwell's Classification of Questions, readability scores, and Brief DISCERN.ResultsThe digital educational materials extracted from the methodology of this study were mostly found to be from "Academic Institutions" at 41.3%. (n = 186) and "Medical Practices" at 30.2% (n = 136). Readability scores indicate that most articles on venous diseases or procedures are considered either "fairly difficult" or "difficult" to read. According to the Brief DISCERN assessment, educational materials on venous disease topics generally received higher quality scores compared to those on venous interventions.ConclusionsThe findings revealed a potential discrepancy in the quality of patient education articles between those related to venous diseases and those related to venous interventions. Articles about venous diseases generally scored higher in quality according to the Brief DISCERN assessment. This may suggest that a more substantial amount of high-quality information is available in this area. In terms of readability, these educational articles generally fell short of recommended grade reading levels.

ObjectiveTo evaluate outcomes in patients with type 2 endoleak (T2E) and the impact of treatment outside the device instructions for use (IFU).MethodsThis retrospective single-center study included abdominal aortic aneurysms (AAA) patients who underwent EVAR (2011- 2024). Primary outcomes were 30-day and mid-term complications, reintervention, and mortality by T2E status. Propensity score matching was applied and secondary analysis stratified outcomes by IFU compliance, comparing within (_inIFU) or outside(_outIFU) IFU in each T2E group.ResultsAmong 154 EVAR patients (137 men (89.1%) and 17 women (11.0%); mean age 77.5 ± 7.6 years), 77 were T2E(-), and 77 were T2E(+). Baseline characteristics were similar. Thirty-day complications were comparable (T2E(-): 5, 6.4% vs T2E(+): 2, 2.56%, P = 0.72). The mean follow-up duration was 2.7 ± 2.4 years. Sac diameter change (Δ) decreased in the T2E(-) (7.7 ± 8.4 mm) and enlarged in the T2E(+) (1.79 ± 12.5 mm; P < 0.01). Mid-term graft-related complications (T2E(-): 3, 3.8% vs T2E(+): 49, 62.8%, P < 0.01) and reinterventions (T2E(-): 3, 3.8%, vs T2E(+): 20, 25.6% P < 0.01) were higher in the T2E(+) with no difference in mortality (P = 1.00). These findings remained after excluding type 1 endoleaks. Among the T2E(+), those treated _outIFU had longer hospital stays (_outIFU: 3.0 ± 2.8 days vs _inIFU: 1.8 ± 2.0 days, P = 0.03), higher T1E (_outIFU: 3, 33.3% vs _inIFU: 1, 4.34%, P < 0.01), higher rates of reintervention (_outIFU: 9, 100.0% vs _inIFU:17; 24.6%, P < 0.01) and higher all-cause mortality than those within IFU criteria (_outIFU: 5, 55.0% vs _inIFU: 13, 18.8%, P < 0.01). IFU status did not significantly affect outcomes in T2E(-) patients.ConclusionsT2E is associated with sac growth and increased reinterventions, but not higher mortality. On subgroup analysis, those T2E(+) treated _outIFU had longer hospitalizations, higher T1E rates, more reinterventions, and higher all-cause; but not aneurysmal-related mortality.

Background: Ischemia-reperfusion injury (IRI) secondary to acute limb ischemia is a complex clinical phenomenon induced by a variety of pathologies, including arterial embolization, arterial thrombosis, vascular trauma, advanced peripheral vascular disease, traumatic crush injuries, and/or prolonged tourniquet application. The restoration of blood flow and oxygen to the limb after an ischemic period, while necessary, is ultimately the driving force of IRI. The exaggerated inflammation, oxidative stress, and tissue damage caused by IRI often lead to limb dysfunction, limb loss, multi-organ failure, and/or death. While no gold-standard therapy currently exists, various in vitro and in vivo models have been developed to explore potential therapeutic strategies. Currently, pharmacological agents with anti-inflammatory and/or antioxidant properties, as well as non-pharmacological strategies, have been investigated, and some agents show promise in mitigating the effects of lower extremity ischemia-reperfusion injury (IRI). Purpose: In this review article, we provide a comprehensive overview of the pathophysiology of IRI, discuss the local and systemic effects of IRI, and examine the experimental models used to investigate IRI. We also outline the current in vitro and in vivo pharmacological and non-pharmacological interventions studied to reduce IRI.