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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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    Factors Affecting the Visceral Suitability of a Multibranched off-the-Shelf Endograft for the Treatment of Thoraco-Abdominal Aortic Aneurysms

    Mazzaccaro D.Avishay D.Nano G.
    8页
    查看更多>>摘要：? 2021Background: To assess the factors affecting visceral suitability of the use of the Zenith T-branchTM system in a group of patients with thoraco-adbominal aortic aneurysms (TAAAs). Methods: Computer tomography angiography (CTA) of patients who presented a TAAA from 01/2015 to 12/2019 were retrospectively examined. Multi-Planar Reconstructions were performed on CTA images to assess the anatomic suitability of the Zenith T-branch in the visceral district. In particular, the branch deviation angle (BDA), and the branch-length were computed for each target vessel. Results: Fifty-four CTA were examined. In 33.3% of these patients the presence of either a common origin of the superior mesenteric artery and the celiac trunk, or the diameter of 1 or more visceral/renal artery limited the visceral suitability of the device. All patients except 1 (97.9%) fitted the BDA criterion when the graft was placed in a position in which the BDA for the SMA was 5 degrees to the left. The branch-length criteria was met in all patients, except for 1 (97.9%), when the graft was placed in the center of the aorta. The eccentrical placement of the endograft decreased the suitability to 93.7%. Conclusions: The Zenith T-branch system can be suitable in the visceral district for about 67% of patients. The target artery diameter was the most limiting criterion. The central location of the graft within the aortic lumen significantly affected the branch-length distance criteria.
      原文链接:
    • NSTL
    • Elsevier

    Postoperative Maximal Aortic Diameter is a Significant Predictor of Dilation of the Residual Dissected Aorta after Aortic Replacement for Acute Debakey Type I Aortic Dissection

    Yamashita Y.Joo K.Okamoto K.Nakata Y....
    8页
    查看更多>>摘要：? 2021Background: This study investigated the impact of aortic diameter on late aortic dilation of the residual dissected aorta after tear-oriented aortic replacement for acute DeBakey type I aortic dissection. Methods: Of 133 patients who underwent aortic replacement for acute DeBakey type I/II aortic dissection between 2008 and 2019, 45 patients with a residual dissected aorta after surgery for acute DeBakey type I aortic dissection and who underwent computed tomography at predischarge and after 1 year were retrospectively assessed. The aortic diameter and false lumen area were measured at 3 levels: the maximal aortic site, seventh thoracic vertebra, and celiac axis. Multivariable Cox regression analysis was employed to identify the predictors of late aortic dilation, defined as an aortic growth rate of ≥5 mm/year or a maximal aortic diameter of ≥55 mm. Results: During a median follow-up of 75 [range: 13–152] months, 6 patients (5 men; mean age: 57 ± 14 years) experienced aortic dilation. All 6 patients had the maximal aortic diameter between the distal aortic arch and seventh thoracic vertebra level at the last computed tomography. Multivariable Cox regression analysis showed that the predischarge maximal aortic diameter was an independent determinant of late aortic dilation (hazard ratio: 2.28/mm, 95% confidence interval: 1.10?5.86). Conclusions: Predischarge maximal aortic diameter is a significant predictor of late aortic dilation in patients with a residual dissected aorta after tear-oriented surgical repair of acute DeBakey type I aortic dissection.
      原文链接:
    • NSTL
    • Elsevier

    Endovascular Repair of Penetrating Aortic Ulcers: Indications and Single-Center Mid-Term Results

    Zhang R.Sun L.Sun W.Yang S....
    9页
    查看更多>>摘要：? 2021Background: Although endovascular repair is used to treat penetrating aortic ulcers (PAUs), the indications for endovascular repair in PAUs remain controversial. The current study evaluated the mid-term results of endovascular repair for PAUs and further explored the endovascular indications for PAUs. Methods: We retrospectively reviewed the clinical data of patients who were diagnosed with PAUs and underwent endovascular repair in our department from October 2018 to August 2020. Endovascular indication included persistent or recurring symptoms, a maximum diameter of the PAU of greater than 20 mm, a maximum depth of the PAU of greater than 10 mm, an increase in the diameter of the aorta at the ulcer of greater than 10 mm annually, and multiple ulcers at the same or adjacent level of the aorta. Patient characteristics, anatomical parameters of the PAU, characteristics of endovascular repair and follow-up data were analyzed. Results: 15 patients were included in the study. 3 patients had PAUs in the aortic arch, 6 PAUs were in the descending thoracic aorta, 4 PAUs were in the abdominal aorta, and 2 PAUs were in the descending thoracic and abdominal aortas. The average age was 70.60±8.27 years. Eight patients were symptomatic. The average depth of the PAUs was 7.32±2.74 mm, and the average diameter was 15.03±6.10 mm. The average operation time was 95.60±33.11 min. Postoperative hospital stay was 3.33±0.61 days. A left subclavian artery chimney stent was implanted in 3 aortic arch cases and 1 occluded case without adverse symptoms during the follow-up period. A bifurcated stent graft was placed in 3 abdominal aorta cases and exhibited good patency during the follow-up period. The duration of follow-up ranged from 3 to 24 months. The follow-up results showed that all PAUs were treated satisfactorily by endovascular repair, and no endoleaks or stent graft-related complications occurred. Conclusion: Endovascular repair is a safe and effective treatment for PAUs, and it may be safely performed in elderly patients and patients with comorbidities. The endovascular indications for PAUs must be further studied and optimized.
      原文链接:
    • NSTL
    • Elsevier

    Isolated Ruptured Paravisceral Penetrating Aortic Ulcers

    Omran S.Raude B.Schawe L.Carstens J.C....
    10页
    查看更多>>摘要：? 2021Background: The goal of this study is to investigate the clinical presentation, treatment options, and outcomes of the patients with isolated ruptured paravisceral penetrating aortic ulcers (PV-PAU). Methods: All patients presenting with acute aortic syndrome from 2015 to 2020 were screened, of which patients with isolated ruptured PV-PAU were included in this retrospective study. Study endpoints were the assessment of treatment options, technical success, and clinical outcome. Outcome measures included major perioperative complications and mortality. Results: Sixteen patients (11 men; median age 68; IQR 60 – 75 years) presented with isolated ruptured PV-PAU were included in this study. The median follow-up was 25 months (range 1 – 51). Ruptured PV-PAUs represented 12.3% of the ruptured aortic aneurysms in all locations. PV-PAUs were found in segment A (n = 8, 50%), segment B (n = 5, 31%), and segment C (n = 3, 19%). PV-PAUs showed a mean protrusion distance of 27±10 mm, a mean neck diameter of 21 ± 7 mm, and maximal aortic diameter of 50 ± 11 mm. Five patients (31%) showed hemodynamic instability on admission and needed intense fluid resuscitation. Of those, 2 patients needed urgent laparotomy with a fast transabdominal supraceliac aortic clamping, one needed an aortic balloon occlusion to obtain rapid aortic control. The open aortic repair was the most frequently performed surgery (11/16, 69%), followed by hybrid procedures (3/16) and parallel graft chimney technique (2/16). Two patients died during the follow-up, calculating for in-hospital and 1-year mortality rates of 6 – 12%, respectively. The postoperative morbidity rate was 31%. Postoperative complications included acute renal failure (31%), pneumonia (25%), and 1case of ischemic colitis (6%). No spinal cord ischemia was reported. Conclusions: Ruptured PV-PAU is a rare and challenging diagnostic and therapeutic entity. Open aortic repair seems to be a reliable option in treating patients with isolated ruptured PV-PAUs. Hybrid procedures and parallel stent-graft techniques can only be used in selected patients.
      原文链接:
    • NSTL
    • Elsevier

    Female sex is independently associated with in-hospital mortality after endovascular aortic repair for ruptured aortic aneurysm

    Ho V.T.Rothenberg K.A.George E.L.Lee J.T....
    6页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Endovascular aortic repair (EVAR) can treat anatomically compatible ruptured abdominal aortic aneurysms (rAAA), but registry data suggests that women undergo more open abdominal aneurysm repairs than men. We evaluate in-hospital outcomes of EVAR for rAAA by sex. Methods: The Vascular Quality Initiative (VQI) registry was queried from 2013 to 2019 for rAAA patients treated with EVAR. Univariate analysis was performed with Student's t-test and chi-squared tests. Multivariable logistic regression was then performed to assess the association between female sex and inpatient mortality. Results: A total of 1775 patients were included (23.8% female). Female rAAA patients were older (P< 0.01) and weighed less (P < 0.01). They were less likely to have smoked (P <.0 001) and had lower creatinine (1.29 vs. 1.43, P < 0.01) and hemoglobin (10.7 vs. 11.7, P < 0.01). Women had smaller maximum aortic diameters (74 vs. 66 mm, P < 0.01) and were less likely to have iliac aneurysms (P < 0.001). Women were more likely to have concomitant femoral endarterectomy (8.5% vs. 4.6%, P = 0.03). Despite having no significant difference in complication or reintervention rates, women had higher rates of in-hospital mortality (45.9% vs. 34.5%, P < 0.01). In a logistic regression model for predictors of in-hospital mortality (χ2 < .01), increased age (OR 1.08, P < 0.01), female sex (OR 1.7, P = 0.02), preoperative cardiac arrest (OR 5.29, P < 0.01), concurrent iliac stenting (OR 2.38, P = 0.02), postoperative mesenteric ischemia (OR 2.51, P < 0.01) and postoperative transfusion (OR 1.06, P < 0.01) were independently associated with in-hospital mortality. Increased preoperative hemoglobin was protective (OR 0.89, P < 0.01) Conclusions: Female sex is independently associated with in-hospital mortality after EVAR for rAAA, suggesting a relationship beyond anatomical, biochemical, and procedural covariates.
      原文链接:
    • NSTL
    • Elsevier

    New Morphological Factor for Predicting Late Proximal Type I Endoleak after Endovascular Aneurysm Repair

    Sugimoto M.Sato T.Ikeda S.Kawai Y....
    9页
    查看更多>>摘要：? 2021Background: Although we have witnessed several cases of late proximal type I endoleak (T1AEL) after endovascular aneurysm repair (EVAR), most patients did not have “hostile neck” preoperatively. We hypothesized that the distance between the lowest renal artery and the neck angulation point and neck length are the 2 most important factors for maintaining long-term proximal sealing. This study evaluated “neck hostility,” which is the product of the distance to the angulation point and the neck length, as a preoperative morphological risk factor for the development of late T1AEL after EVAR. Methods: A retrospective review of a prospectively assembled database was performed for all patients who had undergone EVAR at a single institution from June 2007 to May 2017. Patient demographics and preoperative imaging data were collected, and Cox regression analysis was performed to identify the risk factors for late T1AEL. Results: Of the 655 patients who underwent EVAR during the study period, 115 were excluded due to complex EVAR (n = 14), primary indications for iliac aneurysms (n = 86), primary T1AEL (n = 3), or other reasons (n = 15). Of the remaining 537 patients, twelve patients (2.2%) developed late T1AEL a median of 3.2 (interquartile range [IQR]; 3.0, 5.4) years after EVAR. Receiver operating characteristic (ROC) curve analysis revealed a neck hostility cutoff value of 8. Cox regression analysis revealed that a neck hostility value ≤8 and conical neck anatomy were risk factors for the development of late T1AEL after EVAR. Well-known hostile neck factors such as short neck, severe angulated neck, and severe calcification/thrombus in the proximal neck were not significantly different. Conclusions: The present study demonstrated a correlation between late T1AEL and the product of the angulation distance and the neck length. This factor may be useful for predicting poor late proximal outcomes after EVAR.
      原文链接:
    • NSTL
    • Elsevier

    Prediction of Abdominal Aortic Aneurysm Growth After Endovascular Aortic Repair by Measuring Brachial-Ankle Pulse Wave Velocity

    Ugajin A.Iwakoshi S.Ichihashi S.Inoue T....
    8页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Although endovascular aortic repair (EVAR) has become the dominant therapeutic approach for abdominal aortic aneurysm (AAA), continued sac growth after EVAR remains a major concern and is still unpredictable. Since AAA formation is thought to arise from atherosclerotic vascular damage of the aortic wall, we hypothesize that the severity of atherosclerosis in the AAA wall may influence sac growth. Therefore, we investigated whether brachial-ankle pulse wave velocity (baPWV), a marker of atherosclerosis severity obtained by noninvasive automatic devices, can predict sac growth after EVAR. Methods: The data from all patients who underwent elective EVAR for AAA at a single institution from January 2012 to March 2019 were reviewed. We extracted the baPWV before EVAR and divided patients into 2 groups according to the baPWV cut-off value identified by a classification and regression tree (CART). The primary outcome was significant sac growth, defined as an increment of 5 mm or more in aneurysm size after EVAR relative to the aneurysm size before EVAR. Cox regression analysis was performed to assess the potential predictors of sac growth. Results: During the follow-up period, 222 consecutive patients underwent elective EVAR for AAA. Of these, 175 patients with a median follow-up period of 36 months were included. The baPWV values were classified as <1854 cm/s (Group 0) in 100 patients and ≥1854 cm/s (Group 1) in 75 patients according to the cut-off value identified by CART. During the follow-up period, 10 (10.0%) patients in Group 0 and 18 (24.0%) patients in Group 1 demonstrated significant sac growth (P = 0.021). Risk factors for significant sac growth included baPWV (hazard ratio [HR], 3.059; 95% confidence interval [CI], 1.41–6.64; P = 0.005), age (HR, 1.078; 95% CI, 1.01–1.16; P = 0.036), and persistent type II endoleak (HR, 3.552; 95% CI, 1.69–7.48; P < 0.001). Multivariate analysis revealed that baPWV remained a significant risk factor for sac growth after adjustment for age (HR, 2.602; 95% CI, 1.15–5.82; P = 0.02) and persistent type II endoleak (HR, 2.957; 95% CI, 1.36–6.43; P = 0.006). Conclusions: The baPWV before EVAR was associated with significant sac growth after EVAR; thus, measuring the baPWV may be useful for assessing the risk of future sac growth in patients after EVAR.
      原文链接:
    • NSTL
    • Elsevier

    Performance of Carotid Revascularization Procedures as Modified by Sex

    Cui C.L.Zarrintan S.Marmor R.A.Nichols J....
    12页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Current recommendations on carotid revascularization postulate that women have both increased perioperative risks, such as stroke and death, as well as reduced benefit from intervention. These recommendations do not include data on transcarotid artery revascularization (TCAR). This study strives to compare safety and benefits of TCAR, TFCAS (Transfemoral Carotid Artery Stenting), and CEA (Carotid Endarterectomy) with regard to patient sex. Methods: We performed retrospective analysis of the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) CEA and stenting registries, as well as TCAR Surveillance Project data. We compared outcomes after TCAR, TFCAS, and CEA based on sex. The primary outcome was the rate of in-hospital stroke or death. Secondary outcomes included in-hospital stroke, death, transient ischemic attack (TIA), myocardial infarction (MI), stroke/death/MI, stroke/TIA, and recurrent ipsilateral stroke and/or death at 1-year of follow-up. Results:: A total of 75,538 patients were included, of which 28,960 (38.3%) were female and 46,578 (61.7%) were male. TFCAS females had more than 2 times higher odds of stroke/death (OR:2.85, 95%CI: 2.21–3.67, P < 0.001) and stroke/death/MI (OR:2.23, 95%CI:1.75–2.83, P < 0.001) when compared to CEA females. Odds of TIA were also higher in both TFCAS females (OR:2.01, 95%CI:1.19–3.42, P = 0.010) and TCAR females (OR:1.91, 95%CI:1.09–3.35, P = .023) when compared to CEA females. However, only TFCAS females experienced increased odds of stroke/TIA (OR:1.96, 95%CI:1.45–2.65, P < 0.001) when compared to CEA females. TFCAS males had almost twice the odds of stroke/death (OR:1.74, 95%CI:1.39–2.16, P < 0.001) and 44% higher odds of stroke/death/MI (OR:1.44, 95%CI:1.19–1.75, P < 0.001), and more than 3-times increased odds of death (OR:3.45, 95%CI:2.53–4.71, P < 0.001) when compared to CEA males. Odds of in-hospital stroke were comparable between TFCAS and CEA after adjusting for covariates. TCAR males have half the odds of MI when compared to CEA males (OR:0.52, 95%CI:0.34–0.80, P = 0.003). At 1-year TCAR had comparable risk of stroke/death while TFCAS had increased risk of stroke/death when compared to CEA among both males and females. Conclusion: TCAR performed similarly to CEA in both sexes regardless of symptomatic status. Stroke/death and stroke/death/MI rates were similar in symptomatic and asymptomatic males and females treated by CEA or TCAR. The 1-year outcomes of TCAR were also comparable to CEA in both sexes. It seems that TCAR may be a safe alternative to CEA particularly in women when surgical risk prohibits CEA and while TFCAS is associated with substantial adverse outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Symptom Status of Patients Undergoing Carotid Endarterectomy in Canada and United States

    Li B.Rizkallah P.Eisenberg N.Forbes T.L....
    13页
    查看更多>>摘要：? 2021Background: Previous studies have demonstrated significant geographic variations in the management of carotid artery stenosis despite standard guidelines. To further characterize these practice variations, we assessed differences in patient selection, operative technique, and outcomes for carotid endarterectomy (CEA) in Canada vs. United States. Methods: The Vascular Quality Initiative (VQI) was used to identify all patients who underwent CEA between 2010 and 2019 in Canada and United States. Demographic, clinical, and procedural characteristics were recorded and differences between countries were assessed using independent t-test and chi-square test. The primary outcome was the percentage of CEA performed for asymptomatic versus symptomatic disease. The secondary outcomes were 30-day and long-term stroke or death. Associations between country and outcomes were assessed using univariate/multivariate logistic regression and Cox proportional hazards analysis. Results: During the study period, 131,411 US patients and 701 Canadian patients underwent CEA in VQI sites. Patients from the US were older with more comorbidities including hypertension, diabetes, congestive heart failure, and chronic kidney disease. The use of a shunt, patch, drain, or protamine was less common in the US. Most patients had 70 – 99% stenosis, with no difference between regions. The percentage of CEA performed for asymptomatic disease was significantly higher in the US even after adjusting for demographic, clinical, and procedural characteristics (72.4% vs. 30.7%, adjusted OR 3.91 [95% CI 3.21 – 4.78], p < 0.001). Thirty-day stroke/death was low (1.8% vs. 1.9%) and 1-year stroke/death was similar between groups (HR 0.98 [95% CI 0.69 – 1.39], P = 0.89). The similarities in 1-year stroke/death persisted in asymptomatic patients (HR 0.70 [95% CI 0.37 – 1.30], P = 0.26) and symptomatic patients (HR 1.14 [95% CI 0.74 – 1.73], P = 0.56). Conclusions: There are significant variations in CEA practice between Canada and US. In particular, most US patients are treated for asymptomatic disease, whereas most Canadian patients are treated for symptomatic disease. Furthermore, adjunctive procedures including shunting, patch use, and protamine administration are performed less commonly in the US. Despite these differences, perioperative and 1-year stroke/death rates are similar between countries. Future studies should investigate reasons for these variations and quality improvement projects are needed to standardize care.
      原文链接:
    • NSTL
    • Elsevier

    Intraoperative microembolic signals during carotid endarterectomy

    Kim C.Lee J.Lee S.-J.Yun W.-S....
    6页
    查看更多>>摘要：? 2021 Elsevier Inc.Objectives: Transcranial Doppler ultrasonography (TCD) can detect microembolic signals (MESs) that are one of the pathogenic indications of ischemic stroke. However, MESs are not uncommon findings during carotid endarterectomy (CEA). The aim of this study was to evaluate the association between MESs and postoperative neurologic events (transient ischemic attack [TIA] or stroke) or new brain lesions (NBLs) on magnetic resonance imaging (MRI). Methods: Of the 205 patients who underwent CEA, 160 who were monitored intraoperatively for MES using TCD were enrolled and reviewed retrospectively. MESs were counted until carotid cross-clamping. Postoperative neurologic examination and MRI was performed between postoperative day 1 and 7 in 131 patients. The binary logistic regression model was used to identify independent predictors of postoperative neurologic events or NBLs. Results: MESs during dissection or carotid clamping was observed in 50 patients (31%) and 20 patients (13%) showed MESs > 10. The postoperative ischemic stroke rate was 3% (4/160), and MRI revealed NBLs in 19% (25/131). On univariate analysis, the presence of MESs or MESs > 10 was not related to postoperative neurologic events or NBLs. On binary logistic regression analysis, MESs > 10 was not an independent predictor of NBLs (P = 0.873, OR: 1.129, CI: 0.256 – 4.972). Conclusions: MESs were frequently found during CEA. However, they were not associated with NBLs.
      原文链接:
    • NSTL
    • Elsevier