Vascular and endovascular surgery最新文献

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.

AimTo report on a case of renal vein anterior nutcracker syndrome (ANCS) that was treated using saphenous vein bypass after a failed attempt of renal vein transposition.CaseA 42-year-old female presented with gross hematuria and flank pain. Computed tomography revealed a left renal vein (LRV) anterior nutcracker syndrome. An attempt to perform LRV transposition failed due to short vein length. A saphenous bypass was then harvested to perform a bypass between the inferior vena cava and LRV. At 6-month follow-up, the patient remained symptom-free, and imaging confirmed graft patency.ConclusionSaphenous vein bypass presents a viable option in patients with short renal vein or failed renal vein transposition in cases of ANCS.

BackgroundSecondary aortoenteric fistulas (SAEF) following endovascular aortic repair (EVAR) is an extremely rare event but life threatening. Our review offers comprehensive knowledge on pathophysiology, clinical presentation, diagnosis, and treatment options.AimTo summarize the current literature regarding pathophysiology, clinical, diagnostic and therapeutic approach of aortoenteric fistulas secondary to EVAR.MethodsWe performed a literature search in Pubmed/MEDLINE to identify the literature published about SAEF after EVAR. Cases were summarized in a table and prevalences. Other relevant literature was included in the results sections.ResultsA total of 35 reports (single cases and small series) with 45 patients were included. SAEF after EVAR can result from infection, inflammation, or mechanical factors. Clinical presentation is often non-specific, ranging from a gastrointestinal herald bleed to hemorrhagic shock, or malaise and general infection-related symptoms. Cross-sectional imaging plays a critical role in diagnosing SAEF. The treatment approach involves a multidisciplinary team approach and requires broad-spectrum intravenous antibiotics, endovascular intervention for urgent hemorrhage control, and open surgical intervention for definitive repair. Long-term antimicrobial therapy is essential to avoid reinfection.ConclusionsSAEF following EVAR represents a complex, life-threatening condition with limited evidence-based management strategies. Given the growing prevalence of endovascular procedures, comprehensive knowledge of SAEF is crucial for all health care providers to improve early diagnosis and outcomes.

IntroductionTrue aneurysms of the upper limb, particularly in the hands, are rare and challenging to manage. We aim to report two cases of true arterial palmar arch aneurysms surgically treated.Case ReportThe first case involved a 45-year-old male professional martial artist with an ulnar artery aneurysm extending to the superficial palmar arch in the right hand. The second case was a 32-year-old female administrative assistant with a radial artery aneurysm in the left hand. Despite their respective professions, neither patient had a history of significant trauma, recent excessive training, or prolonged work hours. Clinically, both presented with local pain. Diagnostic imaging confirmed the aneurysms. The surgical interventions included proximal and distal vessel ligation and aneurysm resection under local anesthesia. Both patients were discharged on the first postoperative day without complications and showed no vascular complications during a 5-year follow-up.ConclusionAneurysms with marked rarity require individualized treatment with surgical options tailored to the clinical presentation and vascular status.