Vascular and endovascular surgery最新文献

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.

Objectivestudy aims to assess the clinical efficacy, technical features, and early follow-up outcomes of aortic arch dissection (AD) requiring left subclavian artery (LSA) reconstruction using the aorta arch stent-graft system combined with the endovascular needle system for in situ fenestration.Methods and ResultsEight patients with AD were enrolled in this clinical trial after rigorous screening between July 2021 and August 2022. The 8 patients who participated in this trial were male, with a mean age of 62.0 ± 8.3 years. The total operative time was 148.38 ± 35.06 minutes, and the mean hospitalization time was 11.4 ± 4.4 days. A total of 12 aortic stents were implanted in the 8 patients, and branching stents were implanted in the LSA in all patients. No cases of delayed endoleak occurred. There were no stent- or aorta-related deaths. The 2 deaths that did occur were confirmed to have been due to causes outside of the aorta and were unrelated to the thoracic endovascular aortic repair procedure, with a 1-year stent patency rate of 100%.ConclusionsWe believe that this trial of in situ fenestration achieved satisfactory early results, with reasonable postprocedural stent patency and patient survival, and there were no endoleaks requiring intervention during follow-up. However, long-term follow-up is needed to validate the findings of this trial.Trial registrationClinicalTrials.gov PRS Protocol Registration and Results System (URL: Home - ClinicalTrials.gov, NCT05126446).

PurposeTo determine whether concurrent reporting and follow-up on diagnostic imaging could be used as an effective tool to raise IVC filter (IVCF) awareness in an underserved urban community. Methods: For this prospective study, radiologists at our institution flagged plain-film and cross-sectional imaging in which an IVCF was identified from October 2018 to October 2019. For consent, a phone survey was conducted to assess the patient's knowledge and understanding related to IVC filter placement. Key data points on the survey included patients' awareness of filter presence, placement date, location, difference between filters, satisfaction regarding peri-procedural education, and plan for filter removal. Patients desiring further information were scheduled for follow-up in the Vascular Interventional Radiology clinic. Results: 77 patients were identified with an IVC filter. 34 patients (15 males, 19 females; mean age 56y +/- 13.6 years) consented. 23.5% were unaware of their IVC filter. Of those aware, 61.5% were dissatisfied with their consultation/education during placement and 88% pursued further IR consultation indicating a desire to consult a clinician regarding their filter. During the study, 8 patients with IVCF (23.5%) were deemed no longer medically necessary; 6 underwent retrieval and 2 were pending at study conclusion. Conclusion: In underserved urban communities, patients with indwelling IVC filters may not have received appropriate follow-up instructions regarding filter retrieval or may be unaware they have one altogether. Diagnostic imaging is an effective tool to identify these patients, raise awareness, and improve retrieval of filters that are no longer indicated.

ObjectiveEndovascular aneurysm repair (EVAR) has become a preferred method for treating abdominal aortic aneurysms (AAA) due to its minimally invasive approach. However, identifying factors that influence long-term patient outcomes is crucial for improving prognosis. This study investigates whether machine learning (ML)-based decision tree analysis (DTA) can predict long-term survival (over 5 years postoperatively) by uncovering complex patterns in patient data.MethodsWe retrospectively analyzed data from 142 patients who underwent elective EVAR for AAA at Tokyo Medical University Hospital between October 2013 and July 2018. The dataset comprised 24 variables, including age, gender, nutritional status, comorbidities, and surgical details. The decision tree classifier was developed and validated using Python 3.7 and the scikit-learn toolkit.ResultsDTA identified poor nutritional status as the most significant predictor, followed by compromised immunity, active cancer, octogenarians, chronic kidney disease, and chronic obstructive pulmonary disease. The decision tree identified 9 terminal nodes with probabilities of long-term survival. Four of these terminal nodes represented groups of patients with a high probability of long-term survival: 100%, 84%, 77%, and 60%, whereas the other 5 terminal nodes represented groups of patients with a low probability of long-term survival: 17%, 25%, 30%, 45%, and 47%. The model achieved a moderately high accuracy of 76.1%, specificity of 72.4%, sensitivity of 81.8%, precision of 65.2%, and area under the receiver operating characteristic curve of 0.84.ConclusionML-based DTA effectively predicts long-term survival after EVAR, highlighting the importance of comprehensive preoperative assessments and personalized management strategies to improve patient outcomes.

We report a case of a 77-year-old male with pancreatic cancer and thrombocytopenia who presented with acute stroke symptoms and underwent successful endovascular thrombectomy. During femoral artery closure, an 8-F Angio-Seal device fractured, leaving catheter fragments in the right femoral artery, confirmed on imaging. Device analysis revealed oxidation-induced brittleness, leading to sheath fragmentation. This case highlights a rare complication of Angio-Seal devices, suggesting potential material vulnerabilities that warrant further investigation.

IntroductionIliofemoral deep vein thrombosis (IFDVT) and subsequent pulmonary embolism (PE) are an crucial cause of mortality in cancer patients. There is a lack of evidence on the results of mechanical thrombectomy and thromboaspiration (MTT) procedures performed on cancer patients. The aim of this research was to assess safety, efficacy, and clinical outcomes following MTT for cancer-related IFDVT patients.MethodsFrom July 2020 and April 2022, a total of 14 active cancer patients with symptomatic acute IFDVT were managed with MTT with Mantis device. Primary outcomes included overall survival, venous patency, major bleeding and minor bleeding. Secondary outcomes included duration in intensive care unit and hospital stay, complications, bleeding events, reocclusion and reintervention rates.ResultsIn twelve patients (85.7%), a significant early clinical improvement was found. Median intensive care unit (ICU) stay was 1 (range, 1-4) days, while the median hospital stay was 4 (range, 3-10) days. Recurrence of IFDVT was observed in 14.3% of cases (n = 2) in the study group. No re-intervention was performed in these patients. The overall survival for the study cohort was 85.7% at 6 months, and 71.4% at 12 months. Venous patency rate at 12-month follow-up control was 64.3%. There was a significant decrease in Villalta scores following the procedures (P < 0.0001). The overall procedural complication rate was 28.6%.ConclusionIn cancer patients, MTT promises to be a reliable and successful treatment for IFDVT considering the dramatic early symptomatic improvement, low reocclusion rates, acceptable procedure-related major complications, satisfactory patency rates, and improved patient quality of life.

PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and MethodsA systematic review of all articles discussing transcarotid approach EVAR published in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were conducted. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsIn accordance with the inclusion criteria, 17 articles discussing transcarotid approach EVAR were retrieved, encompassing 18 patients. Among these patients, 6 patients were related to ascending aortic disease, including 4 cases of pseudoaneurysms, 1 case of penetrating ulcer, and 1 case of dissection. 9 patients had descending aortic disease, comprising 6 aneurysms, 2 penetrating ulcers, and 1 pseudoaneurysm. There were 3 cases of abdominal aortic disease, including 2 aneurysms and 1 endoleak. Among these patients, 10 cases had access through the left common carotid artery, and 8 cases had access through the right common carotid artery. One patient experienced spinal cord ischemia and subsequently died of multi-organ failure caused by acute pancreatitis. Additionally, there was one case of minor embolization in the nonsurgical carotid supply area. No cerebral infarctions were observed in the vascular territory of the ipsilateral carotid artery at the surgical approach site.ConclusionsResearch on transcarotid approach EVAR is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This systematic review suggests that transcarotid approach EVAR may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. These findings indicate that this method is associated with a relatively manageable perioperative complications and mortality rates.

ObjectiveThe purpose of this study is to investigate the impact of social determinants of health on access to high volume centers and clinical outcomes in fenestrated abdominal aortic endografting. Further, the effect of center volume in fenestrated endografting on outcomes will be sought as this is ill defined. The data herein have the potential to affect referral patterns and locations of complex fenestrated aortic aneurysm care. If lower volume centers achieve equivalent outcomes to higher volume centers, then limiting access to a small number of centers may not be justified.MethodsVascular Quality Initiative (VQI) was utilized as the data source. Four adverse outcomes categories were investigated : (1) Lack of follow up data in the VQI database at 1 year postoperatively; (2) Thirty day operative mortality; (3) Composite perioperative adverse event outcome; and (4) Twelve month mortality. Social determinants of health exposure variables included rural status, non-metropolitan living area, highest and lowest decile and quintile area deprivation index, insurance status, and non-home living status. Designated categories were created for patients operated on in centers within the top 25% of case volume, centers in the bottom 25% of case volume, and in centers with less than 10 total fenestrated endograft cases. Univariable analyses were performed with Chi-squared testing for categorical variables and t test for comparison of means. Multivariable binary logistic regression was performed to identify risks for the composite adverse perioperative event.ResultsThere was no statistically significant association with the composite adverse perioperative event category, 30-day mortality or 12-month mortality for any of the social determinants of health or center volume categories. Patients who live in rural areas (P = .029) and patients with Military/VA insurance (P < .001) were significantly more likely to be lost to follow up at their index VQI center at 1 year. When accounting for all standard co-morbidities, none of the following variables had any significant association with the composite adverse perioperative event on multivariable analysis: absolute center volume as an ordinal variable (P = .985); procedure at a bottom 25^th percentile volume center (P = .214); procedure at a center with less than 10 total fenestrated cases in the database (P = .521); rural home status (P = .622); remote from metropolitan home status (P = .619); highest 10% ADI (P = .903); highest 20% ADI (P = .219); Lowest 10% of ADI (P = .397). The variables that had a statistically significant multivariable association with the composite adverse event were 3 or 4 visceral vessels stented vs 2 vessels (P < .001), baseline renal insufficiency (P < .001), female sex (P < .001), ESRD on dialysis (P = .002), and history of coronary revasculizaiton (P = .047).