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Annals of vascular surgery
Quality Medical Publishing (Qmp)
Annals of vascular surgery

Quality Medical Publishing (Qmp)

0890-5096

Annals of vascular surgery/Journal Annals of vascular surgeryISTP
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    Antegrade Superficial Femoral Artery Approach Using Manual Compression and 4-F Delivery System for Infrainguinal Occlusive Disease

    Nasr B.Hauguel A.Yven C.Didier R....
    8页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: This study sought to assess the feasibility and safety of antegrade superficial femoral artery (SFA) duplex-guided puncture using a 4-F catheter sheath and manual compression for the treatment of infrainguinal occlusive lesions. Methods: From March 2017 to March 2019, all patients who underwent endovascular treatment employing an antegrade SFA approach for femoropopliteal or below-the-knee lesions were included in this study. Follow-up included clinical and duplex ultrasound examinations at 1 month. The primary endpoint was the frequency of major complications at the puncture site. Results: In all, 71 procedures were performed in 70 patients (46 men; mean age: 79.1 ± 11.5 years), most of whom presented with critical limb-threatening ischemia (n = 59; 83%). Of these 71 procedures, 35 (49.3%) were performed for isolated femoropopliteal lesions and 24 (33.8%) for multilevel lesions. The primary endpoint was observed in 4 patients (5.6%). There were 3 observed hematomas (4.2%): 2 required surgical treatment, and 1 necessitated transfusion without intervention. At 30 days, we reported 1 pseudoaneurysm (1.4%). Conclusions: Our results showed that antegrade SFA puncture is feasible and safe with duplex ultrasound guidance and use of a 4-F catheter sheath.
      原文链接:
    • NSTL
    • Elsevier

    Contemporary Outcomes of in Situ Open Surgical Repair of Mid-Portion and Distal Renal Artery Aneurysms

    Bilman V.Mascia D.Carta N.Santoro A....
    10页
    查看更多>>摘要：? 2021Introduction: The best management of renal artery aneurysms (RAAs) remains controversial, especially when they are located from the mid to distal portions of the main renal artery. Our aim is to evaluate our 10-year experience with in situ open surgical repairs from a cohort of non-proximal RAAs at a single vascular surgery center. Methods: A retrospective review of a prospectively maintained database of all patients who underwent RAA in situ repairs located from the mid to distal portions of the renal artery at our Institution was performed between 2009 and 2020. Data on patient demographics, comorbidities, aneurysm location and morphology, type of in situ technique, and perioperative data were assessed. Postoperative biomarkers and renal function were collected, and mid-term follow-up results were analyzed. Results: A total of 15 RAA located at mid and distal portions of the renal artery repaired with in situ techniques were performed in 15 patients (nine men, mean age 62.4 ± 6.36 years). At diagnosis, 12 patients were asymptomatic; a history of abdominal pain was found in one patient, and two patients had drug-resistant hypertension. Two patients had already undergone previous unsuccessful attempts of endovascular treatment. All patients presented an aneurysm diameter >20 mm (mean diameter 2.75 ± 5 mm). At admission, mean serum creatinine and glomerular filtration rate were 1.10 ± 0.23 mg/dL and 69.8 ± 9.8 mL/min/1.73 m2, respectively. Nine lesions were present in the distal portion of the renal artery, with 4 cases having ≥3 efferent branches and the other 5 with two efferent branches. The other six RAAs were in the mid-portion: in 4 cases, one efferent branch, and in 2 cases, two efferent branches were involved. All patients underwent in situ open repair: an end-to-end anastomosis was performed in 9 cases, aneurysm resection with primary closure in 3 cases, bypass with graft interposition in 2 cases (one iliac-renal reconstruction), and with vein interposition in 1 case. The mean renal ischemia time was 21.8 ± 9.4 min. A significant decrease on renal function was not observed (mean glomerular filtration rate at discharge: 64.8 ± 12.0 mL/min/1.73m2; P > 0.22). During recovery, one patient developed retroperitoneal hematoma treated conservatively. During follow-up (mean 46 months, range 2–135), one patient developed occlusion of a terminal renal artery branch without decreased kidney function. Conclusion: In situ techniques for RAA from the mid to distal portions of the renal artery are technically complex; however, based on our results, these procedures were safe and effective, providing satisfactory early and mid-term outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Clinical and Pathological Correlations in Chronic Venous Disease

    Serra R.Bracale U.M.Chila C.Renne M....
    9页
    查看更多>>摘要：? 2021Background: Chronic Venous Disease (CVD) has a high prevalence in the western world. Varicose veins (VVs) are the main signs of this disease that is characterized by important pathological vessel wall changes. The aim of this study is to correlate the main histopathological abnormalities with related clinical issues of CVD. Methods: A cohort of patients with VVs scheduled for open surgical treatment namely stab avulsion of VVs was recruited. Subsequently, venous tissue from stab avulsion was collected in order to evaluate the following biomarkers: Vascular-Endothelial Growth Factor (VEGF), Protein Gene Product 9.5 (PGP 9.5), Fibronectin (FN), and Matrix Metalloproteinase-9 (MMP-9). The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) criteria were used to classify CVD. Results: Fourteen tissue fragments were processed for histological and immunohistochemical studies. Of these, 43% were from CEAP C2 patients, 36% from CEAP C3 patients, and 21% from CEAP C4 patients. CEAP Class C2 had few to moderate structures positive to VEGF; occasional structures positive to Fibronectin, numerous structures positive to MMP9, few to moderate structures positive to PGP 9.5. CEAP Class C3 had moderate structures positive to VEGF; few to moderate structures positive to Fibronectin; many structures positive to MMP9; few to moderate structures positive to PGP 9.5. CEAP Class C4 had numerous structures positive to VEGF; numerous structures positive to Fibronectin; abundant structures positive to MMP-9; few structures positive to PGP 9.5. Conclusions: In this study, positive VEGF, FN, and MMP-9 structures were found with increasing trends in relation to the disease staging. VEGF and FN are associated with a progressive increase from C2 to C4. The MMP-9 marker has an important positivity even at early stage of the disease, being higher in CEAP C4 patients. PGP 9.5 decreases in CEAP C4 patients and this is concordant to decreased vein wall innervation.
      原文链接:
    • NSTL
    • Elsevier

    The Society for Vascular Surgery Objective Performance Goals for Critical Limb Ischemia are attainable in select patients with ischemic wounds managed with wound care alone

    Crowner J.R.Marston W.A.Freeman N.L.B.Sperger J....
    8页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: To set therapeutic benchmarks, in 2009 the Society for Vascular Surgery defined objective performance goals (OPG) for treatment of patients with chronic limb threatening ischemia (CLTI) with either open surgical bypass or endovascular intervention. The goal of these OPGs are to set standards of care from a revascularization standpoint and to provide performance benchmarks for 1 year patency rates for new endovascular therapies. While OPGs are useful in this regard, a critical decision point in the treatment of patients with CLTI is determining when revascularization is necessary. There is little guidance in the comprehensive treatment of this patient population, especially in the nonoperative cohort. Guidelines are needed for the CLTI patient population as a whole and not just those revascularized, and our aim was to assess whether CLTI OPGs could be attained with nonoperative management alone. Methods: Our cohort included patients with an incident diagnosis of CLTI (by hemodynamic and symptomatic criteria) at our institution from 2013–2017. The primary outcome measured was mortality. Secondary outcomes were limb loss and failure of amputation-free survival. Descriptive statistics were used to define the 2 groups – patients undergoing primary revascularization and patients undergoing primary wound management. The risk difference in outcomes between the 2 groups was estimated using collaborative-targeted maximum likelihood estimation. Results: Our cohort included 349 incident CLTI patients; 60% male, 51% white, mean age 63 +/- 13 years, 20% Rutherford 4, and 80% Rutherford 5. Most patients (277, 79%) underwent primary revascularization, and 72 (21%) were treated with wound care alone. Demographics and presenting characteristics were similar between groups. Although the revascularized patients were more likely to have femoropopliteal disease (72% vs. 36%), both groups had a high rate of infrapopliteal disease (62% vs. 57%). Not surprisingly, the patients in the revascularization group were less likely to have congestive heart failure (34% vs. 42%), complicated diabetes (52% vs. 79%), obesity (19% vs. 33%), and end stage renal disease (14% vs. 28%). In the wound care group, 2-year outcomes were 65% survival, 51% amputation free survival, 19% major limb amputation, and 17% major adverse cardiac event. The wound care cohort had a 13% greater risk of death at 2 years; however, the risk of limb loss at 2 years was 12% less in the wound care cohort. Conclusions: A comprehensive set treatment goals and expected amputation free survival outcomes can guide revascularization, but also assure that appropriate outcomes are achieved for patients treated without revascularization. The 2-year outcomes achieved in this cohort provide an estimate of outcomes for nonrevascularized CLTI patients. Although multi-center or prospective studies are needed, we demonstrate that equal, even improved, limb salvage rates are possible.
      原文链接:
    • NSTL
    • Elsevier

    Intraoperative Cerebral Monitoring During Carotid Surgery: A Narrative Review

    Bozzani A.Arici V.Ticozzelli G.Pregnolato S....
    9页
    查看更多>>摘要：? 2021Background: Intra-operative neurological monitoring (IONM) during carotid endarterectomy (CEA) aims to reduce neurological morbidity of surgery. Objective: This narrative review analyses the role and results of different methods of IONM. Methods: review articles on PUBMED and Cochrane Library, by searching key words related to IONM and CEA, from 2000 up to date. Results: regional anesthesia in some centers represents the “gold standard”. The most often used alternative techniques are: stump pressure, electroencephalogram, somatosensory evoked potentials, transcranical doppler ultrasound, near infrared spectroscopy and routine shunting. Every technique shows limitations. Regional anesthesia can make difficult prompt intubation when needed. Stump pressure shows a wide operative range. Electroencephalogram is unable to detect ischemia in sub-cortical regions of the brain. Somatosensory evoked potentials certainly demonstrate the presence of cerebral ischemia, but are no more specific or sensitive than the electroencephalogram. Transcranical doppler monitoring is undoubtedly operator-dependent and suffers from the limitations that the probe has to be placed relatively near to the surgical site and may impede the operator, especially if it needs constant adjustments; moreover, an acoustic window may not be found in 10% –20% of the subjects. Near infrared spectroscopy appears to have a high negative predictive value for cerebral ischemia, but has a poor positive predictive value and low specificity, because predominantly estimates venous oxygenation as this makes up about 80% of cerebral blood volume. The data on the use of Routine Shunting (RS) from RCTs are limited. Conclusions: currently, with no clear consensus on monitoring technique, choice should be guided by local expertise and complication rates. With reflection, best practice may dictate that a standard technique is selected as suggested above and this remains the default position for individual practice. Nevertheless, current techniques for monitoring cerebral perfusion during CEA are associated with false negative and false positive resulting in inappropriate shunt insertion.
      原文链接:
    • NSTL
    • Elsevier

    Transcarotid Arterial Revascularization Adoption Should not Be Hindered by a Concern for a Long Learning Curve

    Alfawaz A.A.Rossi M.J.Kiguchi M.M.Vallabhaneni R....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Transcarotid arterial revascularization (TCAR) offers a novel technique for carotid artery stenting (CAS) that provides flow reversal in the carotid artery and avoids aortic arch manipulation,thus, potentially lowering ipsilateral and contralateral periprocedural stroke rates. As a new technology, adoption may be limited by concern for learning a new technique. This study seeks to examine the number of cases needed for a surgeon to reach technical proficiency. Methods: Retrospective analysis was performed using a prospectively collected database of all TCAR procedures performed in a tertiary health care system between 2016 and 2020. Patient demographics and anatomic characteristics were collected. Intraoperative variables and perioperative outcomes were examined. These variables were collated into groups for the first 4 procedures, procedures 5–8, and after 8. Independent Samples t test, 1-way ANOVA, and logarithmic regression were used to statistically analyze the data. Results: One-hundred and eighty-seven TCARs were performed by 14 surgeons. One hundred and twenty-two (65%) were male, 59 (32%) were older than 75 years, and 83 (44%) were symptomatic. The most common indications were high-lesions in 87 patients (47%) and recurrent stenosis after CEA in 37 patients (20%). Significant differences were found between the first and second groups of 4 cases when comparing mean operative time (71 vs. 58 min; P = 0.001) and flow reversal time (10.8 vs. 7.9 min; P= 0.004). similar significant differences were found between the first and third groups of 4 cases but not between the second and third groups. There was a reduction in contrast usage and fluoroscopy time after the first 4 cases, however, this did not reach statistical significance. There was no ipsilateral perioperative strokes. One patient had a contralateral stroke on postoperative day 2 due to intracranial atherosclerosis, and there was one perioperative mortality that occurred on postoperative day 3 after discharge. Conclusions: Procedural and flow reversal times significantly shorten after 4 TCAR procedures are performed. Other metrics, such as fluoroscopy time and contrast usage, are also decreased. Complications, in general, are minimal. Proficiency in TCAR, as measured by these metrics, is met after performing only 4 procedures.
      原文链接:
    • NSTL
    • Elsevier

    Transcervical Versus Transfemoral Approach in Carotid Stenting Real World Experience in a Community Hospital

    Toby D.Wassiljev S.Kirchner L.Torsello G....
    9页
    查看更多>>摘要：? 2021 Elsevier Inc.Introduction: Peri-procedural embolic events are the Achilles’ heel of carotid stenting. To overcome this complication, transcervical access to the carotid artery was introduced. In this study we describe our “our life” experience with the transcervical approach in a community hospital. Material and Methods: All carotid stent procedures between January 2010 and December 2020 were included in this retrospective analysis. The transcervical approach was compared to the transfemoral approach. In both procedures open-cell, closed-cell design and hybrid stents were used. In-hospital stroke was the primary outcome measure. Results: A total of 340 procedures were performed, in 184 patients the transfemoral approach was used and in 156 patients the transcervical approach was used. In 12 patients (3.5%) an in-hospital stroke was diagnosed, 4 in the transfemoral group (2.2%) and 8 in the transcervical group (5.1%) (P = 0.14). In the multivariate analyses a symptomatic lesion was associated with in-hospital stroke. Neither type of access nor cell design was associated with increased risk of in-hospital stroke. Conclusions: In contrast to previous studies, we could not confirm the advantages of the transcervical approach. However, conclusions should be carefully drawn, since this study is retrospective and was performed with multiple surgeon and different kind of stents.
      原文链接:
    • NSTL
    • Elsevier

    Influence of Eversion Endarterectomy and Patch Reconstruction on Postoperative Blood Pressure After Carotid Surgery

    Meyer A.Gall C.Verdenhalven J.Lang W....
    9页
    查看更多>>摘要：? 2021Background: Post carotid blood pressure fluctuation and hypertension (PEH) are associated with increased risk for adverse outcome; there is limited evidence on the impact of eversion endarterectomy (E-CEA) versus conventional endarterectomy with patch closure (C-CEA) on postoperative blood pressure course. Patients and Methods: In this retrospective observational study, 859 consecutive carotid endarterectomy procedures between 2004 and 2014 (C-CEA n = 585 vs. E-CEA n = 274), were evaluated. Pre- and postoperative blood pressure values were recorded from recovery room until third postoperative day and compared between both techniques; influences on the dichotomous target variable “at least one postoperative blood pressure peak”, that is need for postoperative vasodilators, were analyzed by a logistic regression model. Influences on postoperative systolic blood pressure were evaluated by a linear mixed effects regression model. Results: Preoperative baseline blood pressure was not different between both comparison groups. During postoperative course, significantly increased mean systolic blood pressure values in the E-CEA group from recovery room to second postoperative day (recovery room C-CEA: 129.2 mm Hg vs. E-CEA: 136.5 mm Hg; P < 0.001; first postoperative day C-CEA: 132.4 mm Hg vs. E-CEA: 139.3 mm Hg; P = 0.0002; second postoperative day C-CEA: 138.6 mm Hg vs. E-CEA: 143.1 mm Hg; P = 0.023) were observed. No hyperperfusion syndrome was detected as wells as no difference in postoperative complication rate. Frequency of antihypertensive interventions was also elevated in E-CEA group (C-CEA 22.1 % vs. E-CEA 31.8 %; P = 0.003). E-CEA (OR 1.591, 95% CI [1.146; 2.202]; P = 0.005) and presence of preoperatively elevated systolic readings (OR 1.015, 95%CI [1.006;1.024]; P < 0.001) was also associated with increased need for antihypertensive interventions. Conclusion: E-CEA was associated with significantly elevated postoperative blood pressure, compared to C-CEA. C-CEA was associated with postoperative blood pressure decrease; however, no difference as to neurologic and surgical complications was detected between both surgical techniques in clinical practice.
      原文链接:
    • NSTL
    • Elsevier

    A Ten-year Single-center Surgical Experience With Symptomatic Complete Vascular Rings

    Charbonneau P.Fabre D.Le Bret E.Mercier O....
    7页
    查看更多>>摘要：? 2021Background: Limited data exist on the management of complete vascular rings (CVR) in adults. We reviewed our institution's surgical experience in the management of these patients. Methods: Between 2010 and 2019, all adult patients that underwent a thoracotomy for a CVR repair were identified. We performed a retrospective medical record review of these patients to characterize their demographics and outcomes. Results: Among the 5 patients identified (3 females, 2 males; Mean age 50 ± 9 years), anatomic variants were right arch and Kommerell diverticulum (KD) in 3 (60%) and double aortic arch in 2 (40%) patients. Indications for operation included dysphagia in 4 (80%), respiratory symptoms in 3 (60%) and aneurysmal KD in 1 (20%) patient. Two right aortic arch exclusion, 1 ligamentum arteriosum (LA) division, 1 LA division combined with a KD resection and 2 aortic reconstructions with interposition Dacron graft under partial cardiopulmonary bypass, were performed. Two carotid-subclavian artery transpositions prior to the thoracotomy were done. The postoperative length of stay was 10.0 (IQR 7.3–14.8) days. One reoperation for chylothorax and 1 for symptoms recurrence were performed for the same patient. Over a follow-up period of 1.4 (IQR 0.4–7.0) years, no mortality or major postoperative complications occurred. At their last follow-up visit, all patients reported no related remaining symptoms, except for persisting mild asthma in 1 patient. Conclusions: Open repair of CVR in adults can be performed safely with low complication rate. Symptoms improved in all patients after definitive repair.
      原文链接:
    • NSTL
    • Elsevier

    Prophylactic Muscle Flaps in Primary Vascular Procedures of the Groin

    Kim E.A.Hansen S.L.Wallace A.B.Piper M.L....
    7页
    查看更多>>摘要：? 2021Background: Complications following vascular procedures involving the groin can lead to significant morbidity. Achieving stable soft tissue coverage over sites of revascularization can help mitigate complications. Prior evidence supports the use of muscle flaps in reoperative groins and in high risk patient populations to reduce postoperative complications. Data regarding the use of prophylactic muscle flap coverage of the groin is lacking. Therefore, the purpose of this study is to evaluate the effect of immediate prophylactic muscle flap coverage of vascular wounds involving the groin. Methods: A retrospective cohort study was performed on all patients undergoing primary open vascular procedures involving the groin for occlusive, aneurysmal, or oncologic disease between 2014 and 2020 at a single institution where plastic surgery was involved in closure. Patient demographics, comorbidities, surgical details, and postoperative complications were compared between patients who had sartorius muscle flap coverage of the vascular repair versus layered closure alone. Results: A total of 133 consecutive groins were included in our analysis. A sartorius flap was used in 115 groins (86.5%) and a layered closure was used in 18 (13.5%). Wound breakdown was similar between groups (25.2% sartorius vs. 38.9% layered closure, P = 0.26). However, the rate of reoperation was significantly higher in the layered closure group (50.0% vs. 12.2%, P < 0.01). Among patients who experienced wound breakdown (N = 36), a larger proportion of layered closure patients required operative intervention (71.4% vs. 20.7%, P = 0.02). Other rates of complications were not statistically different between groups. Conclusions: In patients undergoing primary open vascular procedures involving the groin, patients who underwent prophylactic sartorius muscle flap closure had lower rates of reoperation. Although incisional breakdown was similar between the groups overall, the presence of a vascularized muscle flap overlying the vascular repair was associated with reduced need for reoperation and allowed more wounds to be managed with local wound care alone. Consideration should be given to this low morbidity local muscle flap in patients undergoing vascular procedures involving the groin.
      原文链接:
    • NSTL
    • Elsevier