Vascular and endovascular surgery最新文献

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.

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.