Vascular and endovascular surgery最新文献

BackgroundEndovascular treatment for aortoiliac occlusive disease (AIOD) is still challenging. We propose a stent deployment technique for AIOD using only bare-nitinol stents (BNSs) in a form that is ultimately similar to the normal aortoiliac bifurcation structure.Methods and case seriesThe Endovascular Skirt reCOnstruction of aoRToiliac bifurcation using bare-nitinol stents (ESCORT) technique involves primary implantation of a large BNS, with its distal edge being placed just at the edge of the carina by mounting onto 2 pull-through guidewires from the side of an upper extremity followed by V-stenting using BNSs into the pre-implanted BNS at the terminal aorta. The results of experiments showed that this technique can be achieved by the unique structural characteristic of an E-Luminexx Vascular stent (BD, Tempe, AZ, USA) as a main body in which the stent edge can be advanced beyond the catheter tip. This technique without using stent grafts can avoid recrossing of the jailed guidewire and can reduce the procedural and long-term care that is necessary when using stent grafts, and a future cross-over approach may be established also after treatment. Between 2017 and 2021, the ESCORT technique was performed in 7 consecutive cases of AIOD at our institute. The procedural success rate was 100%, and no complication occurred in any of the patients. Symptom resolution was obtained in all patients. Target lesion revascularization (TLR) was performed in 1 patient with extremely severe calcified lesions. Except for the 1 case requiring TLR, at least 2-year patency was confirmed in patients who were followed up. The establishment of a cross-over system was tried in 2 patients after the procedure, and it was successful in both cases.ConclusionThe ESCORT technique for AIOD is a feasible and beneficial stenting strategy.

Introduction and ObjectiveMay Thurner Syndrome (MTS) is a condition characterized by left iliofemoral vein compression, often leading to lower limb symptoms and complications. This study aimed to evaluate the outcomes of endovascular management for symptomatic, non-thrombotic MTS in a Latin American population.MethodsA retrospective cohort study analyzed 43 patients with MTS who underwent endovascular stenting and anticoagulation between 2018 and 2023 in Bogotá, Colombia. Clinical data, including demographics, symptoms, and comorbidities, were collected. Perioperative outcomes, such as procedure time, complications, and length of stay, were recorded. Postoperative follow-up included stent patency, symptom resolution, and the occurrence of complications.ResultsEndovascular management demonstrated high efficacy, with 83.7% of patients achieving symptom resolution and 100% stent patency at 6 months. No major complications were reported. The average procedure time was 52.6 minutes, and patients were discharged within 1 day of the procedure.ConclusionEarly intervention with endovascular embolization is crucial for patients with MTS and symptomatic pelvic varices. This approach offers a safe and effective solution for managing the condition and preventing complications. The presence of symptoms should be considered an indication for endovascular intervention, rather than waiting for thrombosis development.

IntroductionPost-operative venous thromboembolism (VTE) remains a significant concern after endovenous ablation (EVA) for varicose veins. Risk stratification tools aid identifying which patients have an increased VTE risk. There is no consensus on which currently utilised score is most appropriate for daycase surgery. The aim of this observational study was to compare how 2 institutions utilised the Caprini and Worcester Scores to risk stratify ambulatory EVA patients in real-world practice.MethodsA retrospective review of consecutive patients undergoing truncal ablation under local anaesthetic in 2 separate vascular centres between 2022-23 was performed. Each patient was scored prospectively using either the Caprini and Worcester Score for perioperative VTE risk assessment, and then retrospectively using the alternate tool. Demographics and risk factors were documented and compared between patients categorised as "at risk" by each score. Categorical variables were analysed using Chi-Square and continuous using Mann-Whitney U Tests.ResultsTwo hundred patients undergoing endovenous ablation were included. Over half the cohort were female (n = 122, 61%) and the median age was 53.0 years (range 23-87). Twenty-one percent (n = 42) had a Body Mass Index (BMI) > 30. Overall, 90 patients were flagged as high-risk by either score. Fifty-three patients (26.5%) were flagged by the Worcester Score as either 'moderate' (n = 42, 21%) or 'high risk' (n = 11, 5.5%). Fifty-eight patients (29%) were identified as 'high risk' by the Caprini tool. A significant discrepancy in which patients were categorised as "at risk" by each score was noted, with only 21 patients stratified as "at risk" by both (P = 0.047).ConclusionsA similar proportion of patients were stratified as high risk by each score, however the lack of overlap between the 2 risk assessment tools suggests a discrepancy in what variables are scored for. Further well-powered studies are needed to validate which score is most appropriate for ambulatory EVA.

BackgroundAlthough carotid endarterectomy (CEA) is effective for moderate to severe symptomatic carotid artery stenosis, it carries a risk of postoperative cerebrovascular accident (POCVA). Currently, there is insufficient evidence on the relationship between cranial vascular integrity and intraoperative hemodynamic fluctuations.MethodsIn this retrospective case-control study, we utilised data collected from patients undergoing CEA for symptomatic carotid artery disease between December 2005 and October 2019 in the South Mersey Arterial Centre, UK. Patients with three-dimensional CT angiogram data and evidence of postoperative stroke were considered as cases and matched with those without such evidence considered as controls. 3D-CTA data were analysed following a structured pro-forma and data regarding haemodynamic changes were obtained from operative notes. Variables that showed statistical significance in univariate analysis were included in multivariate logistic regression analysis.ResultsA total of 21 cases and 55 matched controls were identified. Presence of atherosclerotic disease in the vertebral arteries on either side, intracranial atherosclerosis and a drop in the systolic blood pressure were significantly different between cases and controls. Our multivariate logistic regression models indicated that the likelihood of stroke was higher with vertebral artery (V1-V4) stenosis on either side (OR 6.5, 95% CI 1.7-24.6) and an intraoperative systolic blood pressure drop greater than 44 mmHg (OR 6.6, 95% CI 1.6-27.6).ConclusionsThese findings highlight the importance of evaluating posterior circulation abnormalities in POCVA. Moreover, careful intraoperative blood pressure management is crucial in perioperative care. This may aid in developing personalised risk stratification and enhancing intraoperative monitoring during CEA.

Objective: This case report aims to present a new endovascular technique for arterial embolization using a relatively recently developed endovascular device, Shape Memory Polymer (SMP) Embolization Plug (IMPEDE, Shape Memory Medical). Methods: A 66-year-old man presented an asymptomatic common iliac aneurysm with a maximun diameter of 4.4 cm and a previous aorto-bifemoral bypass. Results: An embolization of the common iliac artery aneurysm with 5 units of IMPEDE-FX Rapid Fill (12 mm, Shape Memory Medical) and revascularization from external iliac artery to internal iliac artery through a banana technique with an auto-expandable covered stent (Viabahn 10 × 100 mm, Gore) was performed. Conclusion: The experience obtained after the use of this device has allowed us to increase the therapeutic arsenal for high volume aneurysm embolization.

ObjectiveThis study aimed to evaluate the potential role of the whole-exome sequencing (WES) technique in screening pathogenic genes of non-cirrhotic and non-malignant portal vein thrombosis (PVT) and the clinical efficacy of AngioJet-assisted pharmacomechanical thrombectomy (PMT) with transjugular intrahepatic portosystemic stent shunt (TIPS) to treat this disease.Methods16 patients with acute non-cirrhotic and non-malignant PVT were retrospectively analyzed. 14 patients received genetically diagnosed using the WES technique, ten patients received PMT with or without TIPS and 6 cases received anticoagulation alone. Changes in clinical symptoms, and recanalization of the portal vein (PV) were also recorded.Results4 patients (28.6%) had JAK2 V617 F mutation, 4 patients (28.6%) had PROC mutations, 3 patients (21.4%) had SERPINC1mutations. Among patients treated with anticoagulation alone, 5 patients (83.3%, 5/6) developed cavernous transformation of PV and one patient with JAK2 V617 F mutation achieved complete recanalization of PV. One patient treated with PMT without TIPS developed PV cavernous transformation, eight patients (80%) treated with PMT and TIPS achieved complete or partial recanalization of PV. Three patients who developed intestinal necrosis all had SERPINC1 mutations and one of them died of intestinal necrosis. No recurrence was found during follow-up (1-36 months).ConclusionsThe WES technique offers a promising way to screen for thrombophilia in patients with non-cirrhotic and non-malignant PVT. Patients with SERPINC1 mutations are more inclined to develop intestinal necrosis than others. PMT combined with TIPS provides a safe and effective therapeutic alternative.

ObjectiveAn aneurysm is a localized dilation of a blood vessel, commonly referring to the arterial system, but venous aneurysms, especially in the lower limbs, are significant and often underreported vascular conditions. This study focuses on superficial venous aneurysms at the sapheno-femoral junction (SFJ), categorized as Type IA and IB.Materials and MethodsEleven patients (5 females, 6 males; mean age 50 years) with venous masses were identified after negative hernia evaluations. Diagnosis was established through clinical examination and duplex ultrasound, confirming SFJ dilation with specific inclusion criteria. Surgical excision was performed, followed by follow-up assessments up to 5 years.ResultsAll patients underwent successful surgical excision. No major complications occurred, and all patients ambulated immediately post-surgery. Five years post-operation, there were no inguinal recurrences, and residual great saphenous vein remained patent and continent. Histopathological analysis revealed wall thinning, reduced smooth muscle and elastic fibers, and fibrous connective tissue predominance.ConclusionSuperficial venous aneurysms at the SFJ are rare but can be effectively managed through surgical excision. With appropriate diagnosis and intervention, the risk of complications is minimal, supporting the need for awareness and accurate classification in clinical practice.

Background and AimThe aim of this study is to estimate the incidence of periprocedural outcomes after carotid revascularization with special emphasis on myocardial infarction and assess the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) through systematic review and meta-analysis.MethodsA multiple electronic search was performed in Medline (database provider PubMed), Web of Science Core Collection, EMBASE (database provider Ovid) and Cochrane Central Register of Controlled Trials databases for articles from 2000 up to 2023 reporting outcomes after carotid revascularization. Randomized control trials comparing the perioperative events (30-day results) after CAS and CEA stating the perioperative risk of myocardial infarction were included in the present meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of twelve randomized control trials (RCTs) with 11 153 patients were identified and considered eligible. The pooled risk of periprocedural stroke was found to be reduced after CEA compared to CAS [OR: 1.6, CI 95%:1.3-2.1, P < 0.05], while PMI was found to be more frequent after CEA, favoring CAS [OR: 0.4, CI 95%: 0.2-0.7, P < 0.05]. Periprocedural mortality was lower but not reaching statistical significance in the CEA compared to CAS [OR: 1.1, CI 95%: 0.6-2.1, P = 0.68]. The pooled OR for composite endpoint of stroke, MI or death was in favor of CEA as safer treatment [OR: 1.3, CI 95%: 1-1.5, P < 0.05].ConclusionsPMI risk was lower after CAS, although the currently available data do not demonstrate any increase in mortality rates.

ObjectiveA significant number of patients undergoing abdominal aortic aneurysm (AAA) repair have a prior diagnosis of cancer. Further information on outcomes following AAA repair in patients with recent intra-abdominal malignancy diagnosis could help guide decision making.MethodsWe used the 2005-2016 Surveillance, Epidemiology and End Results (SEER)-Medicare database to examine outcomes of AAA repair in patients with a recent intra-abdominal malignancy diagnosis. Patients who had undergone AAA repair within 2 years following a cancer diagnosis were included in the study and stratified by cancer stage. We used Kaplan-Meir curves and survival models to compare outcomes of AAA repair in patients with cancer to a cohort without cancer.ResultsWe identified 2614 patients with intra-abdominal malignancy and 2680 patients without cancer who had AAA repairs. Cancer stages were: 53% stage I, 31% stage II, 11% stage III and 5% stage IV. Cancer patients were less likely to undergo open repair (20% vs 28% P < 0.001) or emergent repairs (15% vs 24% P < 0.001). Survival 2 years after AAA repair was 81% for patients without cancer and 78% for the cancer cohort. 2-year mortality by cancer stage was 20% for stage I, 20% for stage II, 33% for stage III and 69% for stage IV cancer patients (AHR for 2-year mortality, Stage I 1.10 (95% CI 0.94-1.27), Stage II 1.25 (95% CI 1.05-1.50), Stage III 2.01 (95% CI 1.62-2.50), Stage IV 5.23 (95% CI 4.17-6.56)).ConclusionPatients with late-stage intra-abdominal malignancies had significantly poorer prognosis following repair of a synchronous AAA as compared to patients without cancer. This data could help inform decision making around the role of AAA repair in the setting of concomitant intra-abdominal malignancy.

ObjectiveEndovascular treatment (EVT) for an aorto-iliac occlusive lesion is performed worldwide as first-line treatment. However, the choice of single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT) after aorto-iliac revascularization is controversial. The purpose of the study was to assess clinical outcomes in patients with SAPT or DAPT after iliac EVT, using propensity score matching.MethodPatients who underwent EVT for a de-novo iliac occlusive lesion at a single center from 2017 to 2023 were analyzed retrospectively. Comparisons were made between SAPT and DAPT cases after propensity score matching. The primary endpoints of the study were freedom from restenosis and freedom from target lesion revascularization (TLR).ResultsA total of 150 patients underwent iliac EVT and received SAPT (n = 93) or DAPT (n = 57). The DAPT group had a significantly higher rate of coronary artery disease (P = .010). After matching, the differences in baseline and procedural details were diminished. The technical success rate of EVT, access site complications, and manual compression time did not differ between the groups. The median follow-up period was 33 (20-47) months. During follow-up, restenosis occurred in 11 cases (7%) and 10 cases (7%) underwent TLR. After matching, the 5-year freedom from restenosis did not differ significantly in the SAPT and DAPT groups (92% vs 90%, P = .80). Freedom from TLR also did not differ between the groups (P = .80). There was a tendency for a lower incident rate of major bleeding in the SAPT group (7% vs 18% at 5 years, P = .10).ConclusionsRetrospective analysis using propensity score matching showed that SAPT after iliac EVT resulted in similar freedom from restenosis and TLR compared with DAPT.