Vascular and endovascular surgery最新文献

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).

PurposePaclitaxel is a chemotherapeutic agent which may be administered locally to an arterial lesion via a drug-coated balloon or drug-eluting stent. We report an allergic reaction to locally administered paclitaxel.Case SummaryA 75 year-old woman underwent a right external iliac to superior mesenteric artery bypass and presented a year later with evidence of iliac artery stenosis, which was repaired via angioplasty and stenting. Two years later, the patient presented again with restenosis. She underwent balloon angioplasty of affected vessels with an IN.PACT Admiral® 6 × 40 drug-coated (Paclitaxel) balloon. The patient presented to her local hospital a week later with severe pruritis and a rash, for which she received a dose of parenteral steroid. Despite the patient's denial of changes in medication or environmental changes, she continued to experience hypersensitivity symptoms which required recurrent courses of oral prednisone, diphenhydramine, and cetirizine before finally resolving.ConclusionTo our knowledge, a severe allergic reaction to paclitaxel has not been reported when administered locally using either a drug-coated balloon or a drug-eluting stent. This case emphasizes that severe allergic reactions can occur. Because the drug is embedded in the arterial tissue, it cannot be easily removed, and such allergic reactions should be treated with systemic corticosteroids and antihistamines. The allergic reaction should be self-limited as the drug is eliminated over time.

IntroductionCarotid endarterectomy (CEA) is a cornerstone in stroke prevention for patients with carotid stenosis, with closure techniques including primary, patch angioplasty, and eversion. The aim of this paper is to present a 10-year analysis of outcomes in patients undergoing primary repair and selective patch angioplasty in CEA.MethodsA retrospective, single-center study including all consecutive patients undergoing elective CEA at our institution between 2014 and 2023. The Primary outcomes were technical success and 30-day overall survival, ipsilateral ischemic stroke, reintervention, and major adverse cardiac events (MACE) rates. The secondary outcomes were >30-day ipsilateral ischemic stroke, reintervention and primary patency. All outcomes were analyzed in relation to the carotid closure technique (primary closure, patch angioplasty, or eversion). A Generalized Linear Mixed Model (GLMM) was used to assess the association between closure technique and both early and late outcomes. Kaplan-Meier estimates were used to analyze follow-up outcomes depending on the closure technique.ResultsA total of 625 CEA procedures were performed on 577 patients [mean age: 71 ± 9 years; 30.7% female], comprising 87.4% primary repairs, 10.4% patch angioplasty, and 2.2% eversion CEA. Technical success was achieved in (n = 615, 98.4%) of the procedures, with no significant difference between repair types (P value .947). The mean follow-up duration was 60 ± 38.45 months. Early (<30-day) ipsilateral stroke and reintervention did not differ significantly across carotid repair groups. GLMM analysis showed that congestive heart failure (CHF) was a significant predictor of increased risk for stroke and MACE (OR: 8.870, CI 95% 2.046-38.451, P = .005) (OR: 7.037, CI 95% 1.902-26.038, P = .005), respectively. Regional anesthesia significantly lowered the risks of stroke (OR: 0.216, CI 95% .065-.721, P = .014) and MACE (OR: 0.380, CI 95% .158-.914, P = .032). Long-term (>30-day) ipsilateral stroke and 2-year primary patency were comparable across the groups. GLMM analysis of >30-day stroke revealed no statistically significant differences between patch and primary CEA (OR: 1.947, 95% CI: .321-11.819, P = .363). Neither age >80 years (n = 94, 15%) nor female sex (n = 177, 30.7%) were significantly associated with increased stroke risk (age: OR 0.524, 95% CI: 0.021-7.013, P = .415; sex: OR 0.524, 95% CI: 0.087-3.152, P = .370). The analysis of 2-year patency outcomes revealed no significant associations between patch vs primary CEA, sex, or age greater than 80 years. KM analysis revealed 3-year survival rates of 93% for primary repair, 99% for patch angioplasty, and 90% for eversion (P = .5). Stroke-free survival at 3 years was 95%, 94%, and 100%, respectively (P = .3).ConclusionNo significant differences were observed in early or late stroke, mortality, or 2-year patency on adjusted

ObjectiveThis study aimed to compare 30-day postoperative outcomes of carotid body tumor (CBT) resections performed by vascular surgeons vs otolaryngologists, examining complication rates, operation time, and hospital stay duration.MethodsA retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2020. Patients undergoing CBT resection were identified using CPT code 60605. Only cases performed by vascular surgeons or otolaryngologists were included. The primary outcome was any major postoperative complication, with secondary outcomes including operation time and hospital length of stay. Multivariable logistic and linear regression models adjusted for confounders including age, sex, modified Charlson Comorbidity Index (mCCI), race, surgical setting, and emergency status.ResultsA total of 718 patients (545 vascular surgery, 173 otolaryngology) were included. Patients operated on by vascular surgeons were older (58 vs 51 years, p < .001), had a significantly higher incidence of hypertension (51% vs 36%; p < .001) and mCCI (1.78 ± 1.47 vs 1.25 ± 1.36; p < .001). Otolaryngology surgeries had significantly longer mean operative times (203 vs 145 min, p < .001) and a higher, though not statistically significant, rate of major complications (5.3% vs 2.3%, p = .07). Adjusted multivariable analysis showed otolaryngology specialty was independently associated with increased odds of severe adverse events (aOR: 2.99; 95% CI: 1.15-7.56; p = .021) and longer operation time (aβ: 61; 95% CI: 46-75; p < .001), but not with reoperation rates.ConclusionWhile both specialties achieved generally safe outcomes, CBT resections performed by otolaryngologists were associated with longer operative times and higher odds of major complications. These differences may reflect variations in case complexity, patient selection, or surgical expertise, warranting further prospective research into multidisciplinary and specialty-specific outcomes for CBT surgery.

PurposeThis case report aims to describe the rare and severe complication of carotid artery stent expulsion via an oropharyngeal fistula (OCF) in a 59-year-old male with head and neck cancer. The study emphasizes the unique interplay between oropharyngeal cancer and carotid artery blowout and highlights a novel presentation of OCF in a patient with advanced comorbidities.CaseA 59-year-old male with oropharyngeal squamous cell carcinoma, carotid artery stenosis, and multiple comorbidities underwent chemotherapy, pseudoaneurysm embolization, and carotid artery stenting. Four months after carotid artery stent placement, the patient expelled the carotid stent through an oropharyngeal fistula. Imaging confirmed a chronic fistula and occlusion of the right carotid artery. Remarkably, the patient remained hemodynamically stable due to collateral circulation, allowing for safe discharge without further intervention.ConclusionsThis case illustrates an exceedingly rare presentation of carotid artery stent expulsion through an oropharyngeal fistula in a patient with severe carotid stenosis and head and neck cancer. This case underscores the importance of vigilance in patients with high-risk comorbidities undergoing vascular interventions for head and neck cancers. It also adds to the literature by highlighting a potential, albeit rare, complication of carotid stenting in the context of oropharyngeal malignancy.

ObjectivesIn recent years, the widespread use of vascular imaging and increased workups for atherosclerotic disease have led to more frequent detection. Although the true incidence remains unclear, the number of renal artery aneurysms identified through imaging has increased. Ruptured renal aneurysms are extremely rare and can be life-threatening without emergency treatment. However, only a few studies have focused on its treatment. In this report, we present a case of a ruptured renal pseudoaneurysm treated with endovascular therapy.Case DescriptionA female patient who had previously undergone surgery for a ruptured abdominal aortic aneurysm (rAAA) presented with progressive left-sided lower back pain. Computed tomography revealed a ruptured left renal pseudoaneurysm near the AAA replacement. Chimney endovascular aneurysm repair (Ch-EVAR) was performed immediately. Completion angiography demonstrated no endoleak and preserved flow into the left renal artery. The patient was discharged 4 days post-Ch-EVAR.ConclusionsThis case offers valuable perspectives on managing ruptured renal aneurysms. Ch-EVAR represents a feasible treatment option for such cases. Following treatment for aortic emergencies such as rAAA, careful long-term follow-up is necessary.

ObjectiveTo demonstrate the demographic profile and postoperative outcomes among a large single-center series of patients undergoing carotid endarterectomy for carotid web.BackgroundCarotid artery web (CaW) is a shelf-like intraluminal lesion at the carotid bulb that produces stagnant flow and can result in cerebrovascular ischemia among young and otherwise healthy individuals. While there is no consensus on the ideal management strategy for CaW with ipsilateral stroke, emerging evidence favors open surgical intervention. We present a large single-center experience of carotid endarterectomy for CaW.MethodsSingle-center retrospective review of all patients admitted between January 2016 and September 2023 with acute ischemic stroke, had CT angiography findings consistent with CaW- shelf-like projection at the level of the carotid bulb- and underwent carotid endarterectomy. The main outcome variables were ipsilateral stroke or transient ischemic attack during the follow-up period.ResultsTwenty-three patients who underwent carotid endarterectomy for CaW were identified. The median age was 41 years old [IQR 38 - 47], 19 were female (82%), and 21 were African American (91%). One patient was originally managed with medical therapy alone and presented with recurrent stroke. All patients underwent carotid endarterectomy at a median of 29 days after presentation. Patch angioplasty was used in 16 (70%) patients, 15 with bovine pericardial patch and one with collagen-impregnated polyester patch. The arteriotomy was closed primarily in the other 7 patients. Eleven (48%) patients had mobile thrombus associated with the web present on imaging or surgical exploration. No new cerebrovascular events occurred in the follow-up period, a median of 154 days.ConclusionCarotid endarterectomy is an established procedure that can be applied to the treatment of carotid web in the setting of associated ipsilateral cerebrovascular ischemia. The procedure is associated with minimal complications and demonstrates an absence of recurrent ischemic events at short and medium-term follow-up.