The latest medical research on Vascular Surgery
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about vascular surgery gathered by our medical AI research bot.
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Type 2 endoleak incidence and fate after EVAR in a multicentric series: different results with different devices?Annals of vascular surgery
Aim of this work is describing incidence and fate of type 2 endoleaks (T2EL) in a multi-centric cohort of patients treated by EVAR with Ovation device (Endologix), and compering them with a group treated by Excluder (W.L. Gore & Associates).
retrospective study conducted on 261 patients treated by Ovation, and 203 by Excluder. Outcomes were intraprocedural, 30-day, 12-month, and mean time follow-up T2EL incidence and related reinterventions. Patent inferior mesenteric artery (IMA), ≥3 lumbar arteries (LAs), intrasac thrombus amount, mean common and external iliac arteries diameter, EIA stenosis (>70%), and diameter ≤5mm, iliac tortuosity ratio ≤0.5, thrombosis and calcification were noted, and considered as potentially influencing outcome.
Ovation group patients presented significantly more thrombosed, calcified and tortuous iliac vessels compared to Excluder group. No significant differences were noted in sac thrombosis, IMA, and LAs patency. At completion angiography, T2EL was evident in 57 Ovation and 46 Excluder patients (p=0.832). At 1-month, in 33 Ovation group, and 28 Excluder patients (p=0.726,). At 12-month and mean time (30.14months) follow-up, no differences were evident between two groups: p=0.940 and 0.951, respectively. Log-rank test showed that rate of T2EL related reintervention was not different between the two groups (p=0.46). Regarding anatomical characteristics, in no case a statistically significant difference was observed between patients presenting or not T2EL (p>0.05).
Data showed no significant difference in term of T2EL incidence between the two study groups, none of preoperative anatomical feature was found to be significantly associated with T2EL appearance.
Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis.The journal of vascular access
The aim of this study is to appraise the current literature on the endovascular management options and their outcomes of cephalic arch stenosis in the setting of a failing brachiocephalic fistula for hemodialysis.
A systematic search of the literature was performed using PubMed, Embase, and Google Scholar from January 2000 to December 2017 in accordance with the PRISMA guidelines to investigate the outcomes of endovascular management of cephalic arch stenosis. Data from randomized controlled trials and observational studies, published in the English language, were extracted to determine pooled proportion of primary and secondary patency, using a random-effects meta-analysis. Subgroup analyses of stent grafts, bare metal stents, and percutaneous transluminal angioplasty outcomes were performed.
Of the 125 total studies, 11 were included for analysis by consensus. Overall, 457 patients were reviewed and analyzed for primary and secondary patency rates at 6 and 12 months post-treatment. There was significantly higher primary patency at both 6 and 12 months in the stent graft group compared to those who received bare metal stents or percutaneous transluminal angioplasty (relative risk = 0.30-0.31, relative risk = 0.34-0.59, respectively; p < 0.01). Higher secondary patency rates were noted in the bare metal stents cohort compared to the percutaneous transluminal angioplasty cohort at 12 months (relative risk = 0.17, 95% confidence interval = 0.07-0.26; p < 0.01).
This study demonstrated a significant benefit in using stent grafts in cephalic arch stenosis compared to bare metal stents or percutaneous transluminal angioplasty with higher primary and secondary patency rates.
Peripherally inserted central catheter, midline, and "short" midline in palliative care: Patient-reported outcome measures to assess impact on quality of care.The journal of vascular access
A prospective, observational study was conducted in our palliative care unit to assess the impact of peripherally inserted central catheters (PICCs), midline, and "short" midline catheters on the quality of care in cancer and non-cancer patients. The secondary objective was to assess pain and distress during vascular access device insertion.
Patients were recruited if they underwent insertion of a PICC, midline, or "short" midline catheter as part of their standard care. The Palliative care Outcome Scale was used to assess changes in quality of care after vascular access device positioning. A numerical rating scale was used to measure pain intensity during catheter insertion.
Of the 90 patients enrolled, 52.2% were male with a mean age of 73.0 ± 13 years. Among these patients, 64.4% patients underwent "short" midline insertion, 26.7% PICC, and 8.9% midline catheter. The patients' mean baseline Palliative care Outcome Scale score was 15.7 ± 5.6. Three days after vascular access device positioning, the patients' mean Palliative care Outcome Scale score was 11.5 ± 5.5 (p < 0.0001). Mean pain score during vascular access device insertion was 1.26 ± 1.63, and mean procedural distress score was 1.78 ± 1.93.
These findings suggest that medium-term intravenous catheters can have a favorable impact on quality of care and the procedures for these vascular access device insertions are well tolerated. Further research on the performance of different vascular access devices and their appropriateness in palliative care should be encouraged.
The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: Results of a pilot study.The journal of vascular access
After a kidney transplant, it is unknown whether the maintenance of a functioning hemodialysis arteriovenous access could have deleterious effects on renal grafts. We hypothesize that maintaining an arteriovenous access can deviate a significant proportion of the cardiac output from the renal graft. The aim of this study was to investigate whether a temporary closure of the arteriovenous access could lead to an increase in graft perfusion.
We conducted a study in 17 kidney-transplanted patients with a functioning arteriovenous access. We evaluated, at baseline and 30 s after compression of the arteriovenous access (access flow occlusion), the hemodynamic parameters and the renal resistive index of the graft by Doppler ultrasound.
After arteriovenous access occlusion 82.4% (n = 14) of the patients had a decrease in resistive index. All patients had a decrease in heart rate (67 vs 58 bpm, p < 0.001) and 14 (82.4%) had an increase in mean blood pressure (98.3 vs 101.7 mm Hg, p = 0.044). There was a significant decrease in the resistive index (ΔRI) after the access occlusion (0.68 vs 0.64, p = 0.030). We found a negative correlation in Qa (r2 = -0.55, p = 0.022) with the ΔRI, and Qa was an independent predictor of ΔRI in a model adjusted to pre-occlusion resistive index.
Our results showed that temporary occlusion of an arteriovenous access causes a significant decline in renal graft resistive index and this decline is higher with the occlusion of accesses with higher Qa. These results suggest that the maintenance of arteriovenous accesses, mainly those with higher Qa, can decrease renal graft perfusion.
Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access.The journal of vascular access
To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease.
A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated.
A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months.
For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.
Bilateral external iliac venous aneurysms in a long-distance runner.Annals of vascular surgery
Aneurysms of the iliac veins are very rare, but are potentially fatal due to their potential to cause thromboembolic complications or even rupture....
Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-analysis.Annals of vascular surgery
To assess the current available evidence examining the efficacy of extracorporeal shockwave therapy (ESWT) on healing of diabetic foot ulcers (DFU).
Articles were identified and data extracted by two independent reviewers onto Review Manager 5.3 software.
This review included 5 trials of 255 patients published between 2009 and 2016. 3 studies compared ESWT to standard wound care and 2 studies compared ESWT to hyperbaric oxygen therapy (HBOT). All studies contained unclear to high risk of bias assessed by Cochrane Risk of Bias Tool. ESWT was superior to standard wound care at complete wound healing (OR 2.66 95% CI 1.03, 6.87, I2 0%) and time to healing (64.5±8.06 days versus 81.17±4.35 days). DFU healing improved more with ESWT than HBOT (OR 2.45 95% CI 1.07, 5.61 I2 28%). There was variable evidence of effect on blood flow perfusion rate. Infection rate and amputation rate were not reported.
This systematic review concludes that ESWT has the potential to improve healing in DFUs, although there is, as yet, insufficient evidence to justify its use in routine clinical practice. The meta-analysis has a high risk of bias and is unlikely to reflect true effect size due to problematic risk of bias in included studies. This review highlights the variable quality of methodology of trials and dosing of shockwave therapy, and the need for robust adequately powered research into this promising therapy.
A Complex Case of Synchronous Thoracic And Abdominal Endoleak Repair With Custom-Made Relay Nbs Thoracic Stent Graft And Abdominal Open Reconstruction.Annals of vascular surgery
A 71-year old patient with previous thoracic aneurysm endovascular repair (TEVAR) and endovascular abdominal aneurysm repair (EVAR) presented with ...
Retroperitoneal Liposarcoma Masquerading As An Impending Rupture of Inflammatory Abdominal Aortic Aneurysm.Annals of vascular surgery
We present a unique case scenario of a periaortic liposarcoma masquerading as an impending rupture of an inflammatory abdominal aortic aneurysm (AAA).
A 57-year-old man was referred to our unit for an emergency endovascular repair of "an inflammatory AAA with CT features of impending rupture". He underwent an uneventful endovascular repair with a bifurcated endograft (C3, Gore, Flagstaff, AZ, USA). Seven weeks later, CT showed that the periaortic "mass" grew larger and asymmetric and a CT-guided needle biopsy suggested the presence of a high grade malignant mesenchymal tumor. He underwent laparotomy and excision of the retroperitoneal tumor en bloc with the anterior wall of the infrarenal aorta. The endograft acted as an excellent "safety net" providing adequate hemostatic control and obviating the need for aortic cross-clamping and repair of the aortic defect with a patch or tube graft.
The learning point from the present case is that when faced with an inflammatory AAA and/or retroperitoneal fibrosis, the rare possibility of a retroperitoneal neoplasm should be kept in mind.
Un Faux Anevrisme Tuberculeux De L'isthme De L'aorte Traité Par Endoprothèse.Annals of vascular surgery
Tuberculosis of the aorta is rare, and its localization in the isthmus is exceptional. Tuberculous aortic pseudoaneurysms have a high risk of ruptu...
Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates Following Limb Revascularization.Annals of vascular surgery
Postoperative sub-therapeutic low-dose heparin infusion (LDHI) is sometimes administered in patients undergoing extremity arterial revascularization to maintain graft patency, and decrease risk of thrombosis. However, the safety of this management strategy is unknown.
From 2013 to 2015, we retrospectively reviewed all patients undergoing upper and lower extremity arterial revascularization at a single university-affiliated medical center. Patients were grouped by receipt of LDHI within the first 24 hours postoperative period. Preoperative demographics, comorbidities, intraoperative measures, 30 day postoperative complications, arterial patency rates, and amputation rates were analyzed for each group.
We identified 379 patients who received extremity revascularization, and 56 (14.8%) of them had received LDHI. Patients who received LDHI were less likely to have an elective admission upon presentation (26.8% vs. 56%, p<0.001), or an admission from home (69.6% vs. 81.7%, p=0.04). They were more likely to have preoperative bleeding (44.6% vs. 22%, p<0.01), and need for emergent operation (23.2% vs. 11.8%, p=0.04). Postoperatively, although patients who received LDHI demonstrated a trend towards increased bleeding (48.2% vs. 33.7%, p=0.053), they did not demonstrate an increase in 30-day mortality (1.79% vs. 1.24%, p=0.55), or reoperation (19.7% vs. 12.4%, p=0.21). Multivariable analysis demonstrated that LDHI did not have a significant association with immediate postoperative bleeding (p=0.99), survival (p=0.13), primary patency (p=0.872), and amputation-free survival (p=0.387).
Although LDHI was more likely to be administered in patients who received emergent operations, risk adjusted analysis demonstrated that it was not associated with increased postoperative bleeding, mortality, short-term need for reintervention, or amputation following extremity arterial revascularization.
Ultra Long Inflation in SFA Stenosis and Occluded Lesions Using Guide Liner ("Ultra SOUL"): A Case Report.Annals of vascular surgery
Following an era of the use of several drug-coated balloons in angioplasty, "leave nothing behind" and stent-less strategies have been gaining atte...