Vascular and endovascular surgery最新文献

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.

ObjectiveAcute limb ischemia (ALI) is a time-sensitive vascular emergency that often presents to the emergency department and can result in limb loss or mortality if not managed promptly. Identifying simple, cost-effective biomarkers at the time of initial emergency department evaluation could facilitate early risk stratification and guide timely intervention, particularly in resource-limited settings. This study aimed to evaluate the predictive value of three readily available laboratory markers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and blood urea nitrogen (BUN)/creatinine ratio-for assessing amputation risk in patients with ALI.MethodsWe conducted a single-center, retrospective cross-sectional study of 138 patients diagnosed with ALI who presented to the emergency department between January 2020 and January 2023. Demographic and laboratory data were collected. ROC analysis was performed to evaluate the predictive performance of NLR, PLR, and BUN/creatinine ratio for amputation risk, and multivariate logistic regression identified independent predictors.ResultsAmong the biomarkers analyzed, the BUN/creatinine ratio demonstrated the highest predictive performance for amputation risk (AUC: 0.727, sensitivity: 69.0%, specificity: 68.8%), although the discriminative ability was only moderate. NLR (AUC: 0.666) and PLR (AUC: 0.647) also showed associations with amputation risk, though with lower predictive values. Female gender emerged as an additional independent predictor of amputation risk (OR: 4.16, 95% CI: 1.47-11.81, P = .007).ConclusionsOur findings suggest that the BUN/creatinine ratio may serve as an accessible biomarker with moderate predictive performance, whose main utility may lie in helping to exclude patients at low risk of amputation. While NLR and PLR also showed potential value, further prospective multicenter studies are required to validate their clinical applicability.

ObjectiveHigher education has historically correlated with improved health outcomes, yet its impacts on end-stage renal disease (ESRD) patients undergoing hemodialysis are not well understood. The goal of this study was to characterize patient factors and outcomes associated with initial arteriovenous (AV) access creation by patient education level.MethodsWe performed a single-center retrospective review of patients who underwent initial AV access creation from 2014-2021. Education groups were defined as primary (elementary school), secondary (middle/high school equivalent), and tertiary (college or higher). Univariable, multivariable, and Kaplan-Meier analyses were performed.ResultsWe identified 480 patients with primary (20.2%), secondary (54.6%), or tertiary education levels (25.2%). Patients with primary education were more likely to be of Hispanic ethnicity (58.8% primary vs 17.9% secondary vs 9.9% tertiary; P < 0.0001) or underinsured (Medicaid/uninsured) (62.9% vs 46.2% vs 39.7%; P < .001), but less likely to have English proficiency (27.1% vs 79.4% vs 77.5% tertiary; P < .001).Univariable analysis showed no significant differences in access-related steal or 30-day readmission. On Kaplan-Meier analysis, 2-year survival was 89.5% (primary education), 89.1% (secondary education), and 89.7% (tertiary education) (P = .99). Maturation at 180 days was 80.8%, 75.4%, and 75.3%, respectively (P = .4). On multivariable analysis, neither 30-day index readmission nor loss of primary patency were significantly associated with education level.ConclusionsAlthough education level was not associated with adverse outcomes once patients were undergoing hemodialysis, many of our patients only have primary school education. Earlier attempts at improving healthcare literacy and preventative care should be examined before the deterioration of kidney function.

Blunt abdominal aortic injury has a low incidence and accounts for only 4-6% of aortic injuries. Both prognosis and management depend on the type and the severity of injury.A 23 year-old female patient presented after a high speed motor vehicle collision, with a focal dissection and a near complete occlusion of the distal aorta leading to acute limb ischemia, an unstable L1-L2 spinal fracture and a grade 3 liver laceration. An endovascular repair with an aortobiiliac stent graft was performed with resolution of her ischemic lower extremity pain. At 18 months follow-up visit, the aortoiliac axis was widely patent and the stent was intact.

BackgroundWith the increasing use of diagnostic imaging methods in daily practice, the incidence of visceral artery aneurysms has also risen. VAAs are observed in intra-abdominal regions such as the celiac artery, superior mesenteric artery, inferior mesenteric artery, and renal arteries, with treatment indications and methods varying based on location, size, and symptoms.Case ReportThis clinical report describes the successful endovascular management and short-term follow-up of incidentally detected fusiform aneurysms in the celiac artery and superior mesenteric artery of a 67-year-old male patient using flow-diverting stents.ConclusionThis case highlights the safety, effectiveness, and success of endovascular treatment with flow-diverting stents for fusiform aneurysms involving the celiac artery and superior mesenteric artery.

BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Current diagnostic and treatment guidelines generally advocate for endovascular aortic repair in most cases, with the femoral artery serving as the conventional access route. However, this approach may not be feasible for all patients, particularly those with aortoiliac artery occlusion, necessitating alternative access strategies.Case SummaryThis paper presents a complex case study of a patient with aortoiliac artery occlusion who underwent endovascular aortic repair via the left carotid artery approach for a pseudoaneurysm at the anastomotic site of a descending aortic prosthetic graft. This case underscores the potential value of utilizing the carotid artery as an alternative access route in anatomically challenging situations.ConclusionResearch on transcarotid artery approach endovascular aortic repair is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This case report suggests that endovascular aortic repair via the carotid artery approach may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. While our single case demonstrated successful management with minimal complications, larger studies are needed to fully establish the safety profile and determine if perioperative complications and mortality rates are indeed manageable across diverse patient populations.Clinical ImpactThis study provides valuable insights into the feasibility of the carotid artery as an alternative access route for endovascular aortic repair in patients with aortoiliac artery occlusion. It offers clinicians a potential strategy for cases where the conventional femoral artery route is not feasible. The findings presented herein aim to demonstrate the practicality and relative safety of utilizing the carotid artery for endovascular procedures in anatomically challenging scenarios, contributing to the broader understanding of access alternatives in aortic repair interventions.

A 36-year-old man was presented with hemoptysis. The contrast enhanced chest computed tomography and bronchial angiography revealed multiple bilateral ostial and intraparenchymal bronchial artery aneurysms (BAA) and bilateral primary Racemose hemangioma (PRH). Endovascular embolization with polyvinyl alcohol and n-butyl-2-cyanoacrylate was preferred to occlude the BAAs. Five days after the procedure, the patient was discharged and remained stable without recurrence over the 6 month follow up. To the best of our knowledge, this is the first case of PRH with multiple bilateral BAAs and the second published case of bilateral BAAs. This study aims to describe the successful treatment method employed for management of this rare condition and review the published articles relating to BBA and PRH.

BackgroundThe management of cutaneous dystrophy of lower limb resulting from congenital absence of inferior vena cava (IVC) primarily includes anticoagulation, compression stocking and bypass surgery. However, the clinical significance of surgical intervention for great saphenous vein (GSV) and pathologic perforator veins (PPVs) in combination with compression therapy remains unrecognized.Case ReportWe present a case report of a 44-year-old man experiencing bilateral legs heaviness and pain upon prolonged standing, as well as left leg lipodermatosclerosis due to congenital absence of infrarenal IVC and bilateral common iliac veins. He underwent ligation and stripping of GSV along with ligation of PPVs followed by postoperative compression therapy. After 7 years of follow-up, all symptoms and signs completely resolved with a decrease in venous clinical severity score from 16 preoperatively to 3 postoperatively.ConclusionFor patient with lower limb cutaneous dystrophy due to the absence of IVC, it is feasible to perform high ligation and stripping of the GSV on the basis of accurate anatomic and hemodynamic evaluation, but long-term compression therapy is required.

Background: Paradoxical embolism (PDE) through a patent foramen ovale (PFO) is a rare cause of acute limb ischemia (ALI). When surgical thrombectomy using a Fogarty catheter is not feasible, the DISASTER technique represents a viable and effective endovascular treatment strategy.

Case report: A 51-year-old woman presented with the sudden onset of bilateral lower extremity pain and coldness. She had been receiving estrogen therapy for irregular menstruation. Angiography revealed a claw sign in the distal superficial femoral artery. She declined surgical thrombectomy due to concerns about invasiveness. Catheter-directed thrombectomy and thrombus aspiration were performed using the DISASTER (Diamond-Shaped wire Accelerate Splicing process of Thrombus used for Emergent Revascularization) technique. Ultrasound examination identified a thrombus distal to the left common femoral vein. Anticoagulation therapy with a direct oral anticoagulant (DOAC) was initiated. Comprehensive hematological testing revealed no evidence of an underlying coagulopathy. Additionally, no intracardiac thrombus or valvular vegetations were detected. Transesophageal echocardiography (TEE) identified a Grade 2 patent foramen ovale (PFO), suggesting paradoxical embolism as the likely etiology. The patient remained free of thromboembolic events postoperatively.

Conclusion: This report highlights the feasibility of catheter-directed thrombectomy and thrombus aspiration as an effective alternative to surgical intervention for acute limb ischemia. In cases of ALI of unknown etiology, paradoxical embolism should be suspected. Therefore, a comprehensive evaluation, including venous ultrasound and transesophageal echocardiography, is essential to identify a potential PFO or other embolic sources. Early recognition and appropriate management of paradoxical embolism may help prevent recurrent thromboembolic events and improve patient outcomes.