Vascular and endovascular surgery最新文献

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.

ObjectiveCerament® bone void filler combined with an antimicrobial agent has been shown to be effective in both reducing post operative infections and the treatment of osteomyelitis in orthopaedic surgery. Patients under the care of vascular surgery have significant co-morbidities with a mixture of lower limb arterial insufficiency and poor wound healing secondary to diabetes. Conventional management for heel ulcers relies on the improvement of distal blood flow, debridement of infected tissue and antibiotic therapy, though many patients fail to improve with these measures. The purpose of this case series was to report the outcomes of Cerament® G and V in vascular patients who have not responded to conventional treatments.MethodsConsecutive patients with heel ulceration and osteomyelitis secondary to peripheral vascular disease and/or diabetic complications were included and followed up for a median duration of 8 months. Patients underwent a single application of Cerament® G or V to the calcaneal body and debridement. Outcomes included improvement in ulceration, repeat surgical intervention, amputation rate, further anti-microbial therapy, and impact on mobility.ResultsAfter exclusion of two patients due to death and major limb amputation during index admission, 20 patients were included in the study with a median age of 76 years (range 49-87), of which 70% were males. 14 patients (70%) had improvement in their ulcer appearance at follow up. 4 patients (20%) required repeat Cerament® and 4 patients (20%) required lower limb amputation. 3 (15.0%) patients required further course of anti-microbial treatment. Mobility was improved in 5 patients (25%, P < 0.01).ConclusionIn this case series of high-risk vascular patients, single-stage application of Cerament® for heel ulcers with calcaneal osteomyelitis was associated with improvement of ulcer healing, limb preservation, and improved mobility. Further randomized, controlled studies are needed to confirm efficacy in comparison to standard therapy.

Background: Carotid body tumors (CBTs) are rare neoplasms originating from the carotid body. A comprehensive synthesis of the available evidence is essential to enhance the understanding of this condition among clinicians and researchers. Purpose: This review aims to provide a comprehensive overview of CBTs, encompassing their epidemiology, pathophysiology, clinical manifestations, current treatment modalities, and associated complications. Research Design: A narrative literature review was conducted, synthesizing information from relevant studies identified through a systematic search of electronic databases. Study Sample: The review included studies focusing on human subjects with carotid body tumors, encompassing case reports, case series, cohort studies, and relevant review articles. Data Collection and Analysis: The literature search was primarily conducted in the PubMed database. The search strategy utilized a combination of keywords and Medical Subject Headings (MeSH) terms related to "carotid body tumors," "chemodectoma," and "paraganglioma." Retrieved articles were screened based on titles and abstracts, and full texts of relevant studies were reviewed for data extraction. Data on epidemiology, pathogenesis, clinical features, treatments, and complications were then thematically analyzed. Results: Epidemiological data indicate a slight increase in the global incidence of CBTs, although they remain relatively uncommon. The pathogenesis involves factors such as genetic predisposition, chronic hypoxia, and geographical influences. Clinical presentation is variable, commonly featuring neck masses, carotid sinus syndrome, and voice changes, depending on tumor size and location. Primary treatment options include surgical excision, radiotherapy, and embolization, with the choice of modality influenced by patient age, tumor size, and location. While surgery is often the preferred approach, it carries risks of complications such as cranial nerve injury, stroke, and hemorrhage. The review also identifies and discusses rare complications, including baroreceptor reflex failure. Conclusions: A thorough understanding of the multifaceted aspects of CBTs is crucial for refining diagnostic and therapeutic strategies. This integrated knowledge is expected to contribute to improved patient survival and quality of life.

ObjectiveThe coil embolization is the most common endovascular intervention used to treat splenic artery aneurysms (SAAs) and this study aimed to analyze the safety and efficacy of 3 different coil embolization techniques.MethodsA retrospective study was conducted on 60 patients with SAAs who underwent endovascular intervention at Ningbo NO. 2 Hospital from November 2020 to November 2023. The coil embolization technique included Sac embolization (SE, n = 25), the isolation technique (IT, n = 23) and Stent-assisted coil embolization (SACE, n = 12). Perioperative and follow-up data were collected. The primary outcomes assessed were technical success and 30 day, 12 months, and 24 months survival rates. Secondary outcomes included major complications, early or later re-intervention, Post-embolization syndrome (PES) and freedom from end-organ ischemia.ResultsThe SAAs diameter in the SE group, the IT group and the SACE group were 21 mm (16-35), 21 mm (15-70) and 22.4 ± 2.4 mm, respectively. The technical success rate in the SE and SACE groups was 100%, while in the IT group was 95.7% (22/23). There were no significant differences between the 3 groups in terms of major complication (2/25 SE group, 2/23 IT group, 2/12 SACE group, P = 0.733), PES (4/25 SE group, 8/23 IT group, 1/12 SACE group, P = 0.178), or early re-intervention rates (1/25 SE group, 0/23 IT group, 1/12 SACE group, P = 0.675). The mean follow-up times for the 3 groups were 27.7 ± 10.5 months (SE group), 29.7 ± 9.1 months (IT group) and 22.8 ± 6.4 months (SACE group), respectively. Compared to the SE group, the risk of splenic infarction was higher in the IT group (0% vs 17.4%, P = 0.046). No splenic abscesses, Splenectomy, and late re-intervention occured in the cohort. The 30-day, 12-month, and 24-month mortality rates were 0. During the follow-up, 1 non-aneurysm-related death occured in the IT group (4.3%, 1/23) at 37 months postoperatively.ConclusionAll 3 coil embolization techniques, including the SE, the IT and the SACE, have a favorable safety and efficacy. The IT may have a higher risk of splenic infarction. For SAAs with different anatomical features, the preferred coil embolization technique may be different.

IntroductionThere is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting (CAS). Our objective is to compare the long-term efficacy and safety of different medical regimens after CAS.MethodsThis retrospective observational study included patients with pre-existing atrial fibrillation who underwent CAS from 2011 to 2024. Patients were divided into three treatment groups: dual antiplatelet therapy (DAPT), single antiplatelet therapy plus oral anticoagulation (AA), and triple therapy (dual antiplatelet therapy plus oral anticoagulation, TT). The primary outcome was the incidence of major bleeding. Secondary outcomes included the incidence of clinically relevant minor bleeding, recurrent stroke, and stent thrombosis.ResultsOf the 1047 patients who underwent CAS, 129 met the inclusion criteria: 31 in the DAPT group, 46 in the AA group, and 52 in the TT group. At 3 months, major bleeding events occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 7.7% (4/52) in the TT group (P = 0.71). Ischemic stroke after stent placement occurred in 6.4% (2/31) of cases in the DAPT group, compared to 4.3% (2/46) in the AA group and 1.9% (1/52) in the TT group (P = 0.57). Stent thrombosis occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 1.9% (1/52) in the TT group (P = 0.32).ConclusionOur findings suggest no significant differences in bleeding events or ischemic outcomes among the different antiplatelet and anticoagulation regimens in patients with atrial fibrillation who underwent CAS.

ObjectiveTo report the outcomes of the frozen elephant trunk (FET) technique for patients with chronic aortic dissection and thoracic aortic aneurysm.MethodsPatients undergoing the FET technique using the Vascutek Thoraflex hybrid graft for chronic aortic dissection and thoracic aortic aneurysm from 2013 to 2021 were included. Outcomes included mortality rates, peri-operative complications and aortic related re-interventions. Patients were categorised into aortic dissection and thoracic aortic aneurysm groups.Results39 patients were identified, of whom 56% (n = 22) had a thoracic aortic aneurysm and 44% (n = 17) chronic aortic dissection. Patients with aneurysm had a significantly higher rate of peripheral artery disease at baseline. A significant difference was found in in-hospital mortality rate (27% in patients presenting with aneurysm (n = 6) vs 0% (n = 0) in patients with dissection). Peri-operative complications were 2 (5%) post-operative strokes, 1 (3%) symptomatic spinal cord ischemia, 2 (5%) lower limb ischemia and 4 (10%) ischemic colitis. The median follow-up was 14.8 (2.9-46.5) months. During follow up, mortality from all cause was 18% (n = 7), and aortic re-intervention rate 18% (n = 7) after 39.4 (19.8-45.5) months.ConclusionsThe FET technique is a good therapeutic option for aortic disease of the aortic arch and proximal descending aorta. While the postoperative outcome was acceptable given the high mortality rates of such disease and their treatment, outcomes were better among patients presenting with aortic dissection, particularly in terms of peri-operative mortality.