OBJECTIVE: This study aims to present the medium-term outcomes of Extra-Design engineering endografts with inner branches (EDE-iBEVARs, Artivion) in endovascular aortic repairs of complex aneurysms building upon promising early results. METHODS: A retrospective, international, multi-center study was conducted including consecutive patients who underwent complex endovascular aortic repairs using EDE-iBEVARs between 2018 and 2022. Patient demographics, aneurysm anatomical features, procedural details, reinterventions, complications, and endograft failures during follow-up were assessed. The primary outcome was aneurysm-related mortality. Secondary outcome measures included the freedom from all-cause mortality and reintervention, technical and clinical success, and late related complications including branch instability, endoleaks, and serious adverse events. RESULTS: Our study encompassed a total of 260 patients across 13 European centers. The cohort included patients with thoracoabdominal aortic aneurysms (n = 116), suprarenal or juxta-renal aneurysms (n = 95), and those who had previous open repair or previous endovascular aortic repair with type 1A endoleak (n = 49). Of 982 possible inner branches (937 antegrade and 45 retrograde), 962 (98%) were successfully cannulated and bridged with covered stents during the index procedure. Overall, the endograft was successfully deployed in 98% of patients, and 93% were discharged from hospital following surgery. At 3 years, freedom from aneurysm-related mortality was 97%, whereas the freedom of all-cause mortality was 89%. Freedom from reinterventions was 91% and 76% at 1 and 3 years, respectively. The rate of late complications such as endoleaks or branch instability events was 12% (n = 30). The late branch occlusion rate during follow-up was 1.5% (n = 15), of which 12 were renal branches. CONCLUSIONS: EDE-iBEVARs demonstrate satisfactory medium-term outcomes with reintervention rates comparable to other endografts. Encouragingly, rates of branch patency were high, and major adverse events were low. This technology could expand the treatment options for patients with challenging complex aortic conditions.
PURPOSE: To describe a single-center experience in the treatment of chronic limb-threatening ischemia (CLTI) with the application of BeBack catheter (Bentley InnoMed, Germany) in patients with arterial chronic total occlusion (CTO). MATERIALS AND METHODS: A retrospective review of patients who underwent limb revascularizations using the BeBack catheter between 2015 and 2022. All patients had an initial failed attempt using a traditional guidewire and catheter technique. Technical success was considered whenever a successful re-entry or lesion crossing using the study device was achieved. Procedural success was defined as recanalization of the occluded artery with residual stenosis of less than 30%, and improvement in ankle-brachial index (ABI) after 24 hours. A Rutherford score was assigned to each limb and affected anatomical segments and lesion length were documented. Procedural access sites and complications were noted. RESULTS: The study included 72 patients who underwent 78 procedures using the BeBack crossing catheter. Procedural success was achieved in 91% of cases, with a technical success rate of 92.3%. The most frequently involved occluded segments were the femoral and popliteal arteries. The average ABI improved from 0.59 to 0.95 after the procedure. The most used access site was the contralateral femoral, and the BeBack catheter was employed on 85 occasions. Only 1 patient suffered a severe immediate adverse effect, and during the 30-day follow-up period, 2 patients needed reintervention. Unfortunately, 3 patients died during the follow-up period. CONCLUSION: The BeBack catheter offers a viable option for the treatment of patients with chronic total occlusion, with high procedural success and a low complication rate. CLINICAL IMPACT: The BeBack catheter presents a notable advancement for clinicians managing chronic limb-threatening ischemia (CLTI) and arterial chronic total occlusion (CTO), showcasing over 90% procedural and technical success rates in this study. Its adept ability to navigate and recanalize occluded segments provides a robust alternative, especially when traditional techniques falter. This innovation may chane clinical strategies in vascular interventions, offering an efficient and reliable option, thereby potentially enhancing patient outcomes in limb revascularizations.
PURPOSE: To evaluate tibial single access in treatment of chronic total occlusions (CTO) in patients with ipsilateral chronic-limb ischemia (CLTI). MATERIALS AND METHODS: In this retrospective study, data was collected on patients treated for ipsilateral CTO via a tibial artery access between March 2017 and March 2021. Fifty-nine limbs in 57 patients, (42 men, average age 73 years; range 47-96) were treated. Patient's symptoms were classified in accordance with the Rutherford category. The end points were freedom from major amputation and the need for reintervention up to 1 year of follow up. RESULTS: Out of the 59 treated limbs, technical success was achieved in 57 (97%). The treated multilevel segments involved 5 common and 12 external iliac arteries, 23 common and 37 superficial femoral arteries, 23 femoropopliteal segments, 14 popliteal arteries, and 4 bypasses. Mean length of occlusion was 186 mm (range 7-670). Rutherford classification of the treated limbs was category 5 and 6 in 45 patients and category 4 in 14 patients. Three procedural complications occurred and were successfully treated during the same procedure. No immediate post-procedural complication was encountered. Median follow-up was 13 months (range 1-45.3). Reintervention was required in 9 limbs, after an average of 6 months. One year free from amputation rate was 91.2%. CONCLUSIONS: Single access via the ipsilateral tibial artery can be a useful, effective, and safe approach for treating CTO in CLTI patients.
BACKGROUND: The aim of this single-center study was to evaluate the early results of the off-the-shelf inner branch E-nside endograft in the treatment of complex aortic aneurysms and thoracoabdominal aortic aneurysms. METHODS: We performed a retrospective analysis of a prospectively maintained database of all patients treated with the E-nside endograft at our institution during the years 2021-2023. Parameters evaluated were technical success, early major adverse events, target vessel patency, and the presence of endoleaks. RESULTS: In total 16 patients underwent treatment with the E-nside endograft. Six additional patients were evaluated for the device but were excluded due to anatomical considerations. Mean age was 71 (range 59-84) and 14 (88%) were males. Mean aneurysm diameter was 66 mm (range 54-85). Aneurysms treated included thoracoabdominal in 9 (56%), juxtarenal aneurysms in 5 (31%), postdissection aneurysm in 1 (6%) and a type 1A endoleak after a failed endovascular aneurysm repair in 1 (6%). Five of the treated aneurysms were symptomatic. A total of 58 side branches were placed into target visceral arteries. Mean operative time was 190 min (range 150-360). Technical success was achieved in 15/16 of the patients (94%). At 30 days, 1 perioperative mortality and 3 major adverse events occurred, 2 of them branch related. CONCLUSIONS: The E-nside endograft is a feasible option for the treatment of a broad spectrum of aortic pathologies. As it is an off-the-shelf device, it can be used selectively in elective and emergent settings with acceptable 30-day mortality and morbidity. Further follow-up is required to determine the durability of this treatment option and patency of side branches.
BACKGROUND: To determine the outcome of children treated for acute limb ischemia (ALI) in pediatric intensive care units (ICUs). METHODS: A single-center, retrospective cohort study including all patients diagnosed with ALI between 2005 and 2022 in 2 different pediatric ICUs: respiratory and cardiac ICU. Data collected included patients demographics and comorbidities, location and cause of arterial occlusion, and type and duration of therapy. Primary end point was freedom from amputation. Secondary end point was all-cause mortality. RESULTS: A total of 78 patients (58% male) with ALI were included in the study. Median age was 3.8 months (range 0.03-201). The lower extremity was involved in 55 (70%) patients. The limb ischemia was caused by arterial instrumentation in 94% of the patients. Anticoagulation was administered as the first-line therapy in all patients. Unfractionated heparin was administered for a median duration of 5 days (range 1-48). Low molecular weight heparin was continued for a median period of 28 days (range 4-420). Thrombolytic therapy was administered in 5 patients and 2 required surgical revascularization, all for failure of anticoagulation therapy. Mean follow-up was 21 months (range 1-188 months). None of the patients required major upper or lower extremity amputations during or after the index admission. Overall survival at 30 months was 68%. The causes of mortalities were unrelated to the limb ischemia. CONCLUSIONS: This large, single-center study demonstrates that ALI in the pediatric ICU population can be treated conservatively and is associated with a low amputation rate following nonoperative management. The favorable outcome exists regardless of the etiology of the ALI and underlying diseases.
Arterial Occlusive Diseases , Peripheral Vascular Diseases , Child , Humans , Male , Female , Heparin , Retrospective Studies , Limb Salvage , Treatment Outcome , Risk Factors , Peripheral Vascular Diseases/surgery , Ischemia/diagnostic imaging , Ischemia/etiology , Lower Extremity/surgery , Arterial Occlusive Diseases/surgery , Acute Disease
Background: The workload of vascular surgeons is widely affected by the procedural activity of other departments within the same medical center. The purpose of this study was to evaluate the trend in emergent vascular surgery procedures over a 5 year period in a tertiary referral hospital and categorize these procedures based on the nature of the operative procedure required. Methods: A single center, retrospective review of all emergent surgical operations performed at our tertiary referral hospital between the years 2017-2021. Data collected included types of emergent vascular surgery performed, in addition to procedures performed by the departments of interventional cardiology (IC), interventional radiology (IR), neurointerventional radiology (NIR) and extracorporeal membrane oxygenation (ECMO) at our institution. Results: During the study period were performed a total of 1783 operative procedures (mean 356 ± 26/year). Of those, 485 (27%) were emergent cases. We observed a gradual increase in emergent operative procedures performed from 2017 to 2021 (22% to 34% of all cases, increase of 56%, P<.01). A striking increase was seen with vascular repairs performed for iatrogenic vascular injuries secondary to arterial access complications (47% to 65% of all iatrogenic vascular injuries, increase of 38%). The increase correlated with an increase in activity seen in the departments of IC, IR/NIR and ECMO (15%, 31% and 300%, respectively). Conclusions: An increasing number of emergent surgical procedures performed by our vascular surgery department correlates with the increasing number of endovascular procedures performed by non- vascular services. As these procedures are expected to increase, together with the number of stroke units and ECMO units being created, medical centers must be aware that these may result in a significant increase in the workload of the vascular surgery department in order to deal with complications associated with these procedures.
Extracorporeal Membrane Oxygenation , Vascular System Injuries , Humans , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/methods , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/etiology , Vascular System Injuries/therapy , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Retrospective Studies , Iatrogenic Disease
BACKGROUND: Access vessel complications during endovascular aneurysm repair (EVAR) remain a concern and has been reported to occur in 3-10% of cases. The purpose of this study is to report our experience with intraoperative, non-invasive calf blood pressure (BP) measurements and ankle brachial indexes (ABIs) before and immediately following EVAR, in evaluating the perfusion of the lower extremities and detecting early lower extremity ischemia (LEI). METHODS: We performed a retrospective review of all consecutive patients who underwent EVAR at our institution between the years 2019 and 2021. All patients had blood pressure cuffs placed on their calves prior to the procedure. Calf BP measurements and ABIs were obtained prior to and immediately after the surgery. Based on the BP measurements, patients were categorized into two groups. Group 1: patients with unchanged ABIs at the end of the procedure. Group 2: patients who experienced a decrease in ABIs at the end of the procedure (no BP obtained or decrease of ABI >0.3 from preoperative measurement). Patients in group 2 underwent exploration of the access vessel. Based on these, the positive and negative predictive values of the study were calculated. RESULTS: During the study period we performed 113 EVAR procedures for abdominal, thoracic, and thoracoabdominal aortic aneurysms, in which 226 femoral arteries were accessed. Mean age was 71 years and 88% were males. In 219 (97%) of the limbs, there was no change in calf BP measurements and ABIs immediately after the procedure, when compared to the preoperative measurements, and none suffered a decrease in follow up ABIs. In 7 limbs (3%), there was a decrease in the calf BP (group 2), and all underwent exploration of the femoral artery. In 5 of these, a pathology was found within the artery. The positive predictive value of the intraoperative calf BP measurement was 71%. The negative predictive value of the study was 100%. CONCLUSION: Intraoperative calf BP and ABIs is a simple method to assess the lower limb perfusion and detect LEI following EVAR. The exam is particularly accurate in ruling out LEI as it has a very high negative predictive value. However, an abnormal measurement does not necessarily confirm LEI.
PURPOSE: To assess the technical success of GoBack™ crossing catheter in chronic total occlusion. MATERIALS AND METHODS: A retrospective review of chronic limb threatening ischemia (CLTI) patients treated for chronic total occlusions (CTO) with the application of the GoBack™ crossing catheter (Upstream Peripheral Technologies, Haifa, Israel) between May 2020 and January 2021 was performed. Sixteen GoBack catheters were applied in twelve limbs in 12 patients (ten men, average age 75.7 years). Treated limbs were classified as Rutherford Category 5 and 6 in ten patients and four in two patients. Average occlusion length was 287 mm (62-466). All occluded arteries were heavily calcified. Technical success was defined as successful application of the GoBack catheter for lesion crossing or luminal reentry. RESULTS: Successful application of the four French catheter was achieved in 11 of the 12 cases (92%) for reentry in external iliac (1), superficial femoral (2), popliteal (2) and posterior tibial (1) arteries in six out of six cases (100%) and lesion crossing in popliteal (4), peroneal (1) and posterior tibial arteries in five out of six cases (83%). The 2.9 Fr catheter was successfully applied once out of four (25%) in lesion crossing in the posterior tibial artery. CONCLUSION: The GoBack™ 4 Fr crossing catheter in revascularization of CLI patients with CTO could be valuable when manual crossing or reentry is unsuccessful and is applicable from any access site.
Arterial Occlusive Diseases , Peripheral Arterial Disease , Aged , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/therapy , Catheters , Chronic Disease , Chronic Limb-Threatening Ischemia , Femoral Artery , Humans , Ischemia/diagnostic imaging , Ischemia/therapy , Male , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/therapy , Retrospective Studies , Tibial Arteries , Treatment Outcome
OBJECTIVE: To compare the use of biological autologous excised varicose vein dressing (VenoDress) compared to conservative dressing on the ulcer bed during endovenous ablation. METHODS: This retrospective non-blinded study included all consecutive patients with primary or recurrent venous leg ulcers (VLU) with superficial varices treated in one center between September 2019 and October 2020. They all underwent venous ablation, wound debridement, and when needed phlebectomy. On the study group, the excised veins were incised, formed into a sheet, and applied onto the debrided wound bed with the endothelial side facing the wound bed. Adhesion was assessed weekly for 3 weeks. The study group was compared to a control group that underwent similar procedures but with the debrided wound bed treated with low-adherent paraffin dressing. The primary outcome was complete wound healing at 1 and 3 months, and the secondary outcomes were wound-related pain and leg edema. RESULTS: Complete wound closure was documented in 17/26 study group patients at 1 month (65%) and in 25/26 (96%) at 3 months. Complete wound closure was documented in 37/82 patients in the control group (45%) and in 67/82 (82%) at 3 months. The 1-month healing rates were significantly in favor of the VenoDress group when adjusted to sex and diabetes: odds ratio = 2.81 (1.05-7.532), p = .04. The preoperative pain level of the study group (as measured by a visual analog scale VAS (0-10) decreased from 4.96 ± 2.71 to 0.73 ± 1.36 at 1 week and that of the control group from 4.8 ± 2 to 1.35 ± 1.38 at 1 week (p < .001). CONCLUSION: the use of autologous varicose veins as dressing effectively reduced pain in VLU patients compared to conventional techniques. Although its effects on wound closure appear highly promising, further validation is warranted in a randomized comparative study.
Varicose Ulcer , Varicose Veins , Bandages , Humans , Pain , Retrospective Studies , Treatment Outcome , Ulcer , Varicose Ulcer/surgery , Varicose Veins/surgery
PURPOSE: To evaluate the use of inframalleolar access for endovenous ablation when treating advanced venous disease with nonthermal nontumescent (NTNT) techniques. METHODS: This single-center retrospective study included 109 patients with advanced venous disease, treated using inframalleolar access between May 2018 and March 2020. NTNT techniques included ClariVein (Merit Medical Systems, South Jordan, Utah) and ScleroSafe (VVT Medical, Kefar Sava, Israel). Outcomes measured were postprocedure pain, leg edema, ulcer healing and recurrence rates, and venous insufficiency recurrence. RESULTS: Seventy-seven patients (70%) were treated with ClariVein and 32 (30%) with ScleroSafe. Postprocedure pain score (range, 0-10) after 1 week decreased from a preprocedure median of 5 (interquartile range, 3-6) to 1 ((interqartiel range, 0-2) (P = .0001). Complete wound healing was achieved in 38 patients (43.7%) after 30 days and in 71 patients (81.6%) after 90 days. One patient developed an ulcer recurrence and six developed venous insufficiency recurrence. There was no reported nerve or skin injuries. CONCLUSIONS: NTNT ablation techniques using inframalleolar access are effective and safe without risk of nerve damage. Their use facilitates ulcer healing and limits pain in patients with advanced disease.
Endovascular Procedures , Polidocanol/administration & dosage , Saphenous Vein , Sclerosing Solutions/administration & dosage , Sclerotherapy , Sodium Tetradecyl Sulfate/administration & dosage , Varicose Ulcer/therapy , Venous Insufficiency/therapy , Aged , Endovascular Procedures/adverse effects , Female , Humans , Male , Middle Aged , Polidocanol/adverse effects , Recurrence , Retrospective Studies , Saphenous Vein/diagnostic imaging , Sclerosing Solutions/adverse effects , Sclerotherapy/adverse effects , Sodium Tetradecyl Sulfate/adverse effects , Time Factors , Treatment Outcome , Varicose Ulcer/diagnostic imaging , Venous Insufficiency/diagnostic imaging , Wound Healing
Using entry and re-entry analysis we report a simple technique designed to solely manage the fenestrations in an aortic aneurysm caused by chronic type A or B dissections. With meticulous computed tomography mapping of each fenestration, endovascular management can be customized to those areas only. Several cases are presented using this selective approach resulting in durable thrombosis of the false lumen. Targeted coverage of fenestrations in a chronic type B dissecting aneurysm is a feasible and effective management option resulting in reliable false lumen occlusion whilst maintaining visceral perfusion.
We report the case of a 69-year-old woman with Marfan syndrome and a history of multiple thoracic aortic surgeries and a coexisting dissection of her abdominal aorta. She had presented with a ruptured para-anastomotic thoracic aortic aneurysm due to an infected graft. She was treated with two parallel Nellix endografts that were placed in the true and false lumens. The surrounding endobags were inflated with a polymer that completely sealed the ruptured aorta and preserved blood flow to the visceral arteries. Postoperative imaging showed complete exclusion of the aneurysm with patency of all aortic branches and no evidence of endoleak.
The chimney endovascular aortic repair technique is an established option for the treatment of juxtarenal aortic aneurysms. Failure of this repair represents a major surgical challenge. We report the case of a patient treated previously with chimney endovascular aortic repair (for a juxtarenal aortic aneurysm), who had developed a large type IA endoleak. The patient was treated with a custom-made endograft with three inner branches. All vessels were successfully cannulated and bridged, no evidence of endoleak was seen on the completion angiogram, and the patient had an uneventful recovery.
OBJECTIVE: We sought to determine the benefit of performing multiple tibial artery revascularization compared with single vessel revascularization for patients with chronic limb-threatening ischemia (CLTI). METHODS: We performed a single-center, retrospective cohort study of all patients with CLTI treated with below-the-knee endovascular intervention from 2012 to 2019. Group 1 included patients who had undergone single tibial artery revascularization. Group 2 included patients who had undergone multiple (two or more) tibial artery revascularization. More proximal disease, if present, was treated, in addition to the tibial disease. The primary endpoint was freedom from amputation. The secondary endpoints included the reintervention rates and all-cause mortality. RESULTS: A total of 527 limbs in 470 patients with CLTI (nonhealing ulcers, 62%; gangrene, 33%; and ischemic rest pain, 5%) were included in the present study. Of the 527 limbs, 245 (46%) had undergone single vessel revascularization and 282 (54%) had undergone multiple vessel revascularization. The mean follow-up was 19 ± 18 months. No difference was found in freedom from amputation between the two groups (68% vs 63%; P = .109). On multivariable analysis, the factors associated with amputation included dialysis (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16-2.45), dyslipidemia (OR, 1.37; 95% CI, 0.96-1.94), and gangrene (OR, 2.08; 95% CI, 1.50-2.98). No differences were found in the reintervention rates between the two groups (21.2% vs 16.7%; P = .13). The overall survival rate was 73% in both study groups. CONCLUSIONS: The results from the present large, single-center study have demonstrated that multiple below-the-knee vessel revascularization is not associated with improved limb salvage compared with single vessel revascularization.
Angioplasty, Balloon , Ischemia/therapy , Limb Salvage , Peripheral Arterial Disease/therapy , Tibial Arteries , Aged , Aged, 80 and over , Amputation, Surgical , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Chronic Disease , Databases, Factual , Female , Humans , Ischemia/diagnostic imaging , Ischemia/mortality , Ischemia/physiopathology , Male , Middle Aged , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/mortality , Peripheral Arterial Disease/physiopathology , Progression-Free Survival , Retrospective Studies , Risk Assessment , Risk Factors , Self Expandable Metallic Stents , Tibial Arteries/diagnostic imaging , Tibial Arteries/physiopathology , Time Factors
The distal ischemic steal syndrome (ISS) is a complication following the construction of an arteriovenous (A-V) access for hemodialysis. The ability to non-invasively monitor changes in skin microcirculation improves both the diagnosis and treatment of vascular diseases. In this study, we propose a novel technique for evaluating the palms' blood distribution following arteriovenous access, based on thermal imaging. Furthermore, we utilize the thermal images to identify typical recovery patterns of patients that underwent this surgery and show that thermal images taken post-surgery reflect the patient's follow-up status. Thermal photographs were taken by a portable thermal camera from both hands before and after the A-V access surgery, and one month following the surgery, from ten dialysis patients. A novel term "Thermo-Anatomical Segmentation", which enables a functional assessment of palm blood distribution was defined. Based on this segmentation it was shown that the greatest change after surgery was in the most distal region, the fingertips (p < 0.05). In addition, the changes in palm blood distribution in both hands were synchronized, which indicates a bilateral effect. An unsupervised machine learning model revealed two variables that determine the recovery pattern following the surgery: the palms' temperature difference pre- and post-surgery and the post-surgery difference between the treated and untreated hand. Our proposed framework provides a new technique for quantitative assessment of the palm's blood distribution. This technique may improve the clinical treatment of patients with vascular disease, particularly the patient-specific follow-up, in clinics as well as in homecare.
Arteriovenous Shunt, Surgical , Vascular Diseases , Fingers/surgery , Hand , Humans , Renal Dialysis/adverse effects , Treatment Outcome
BACKGROUND: Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage. OBJECTIVES: To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage. METHODS: A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015-2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years. RESULTS: A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%, P < 0.01) and statins (72 % vs. 87%, P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %, P = 0.01), tibial and pedal retrograde access (0 vs. 10%, P = 0.01), and tibial stenting (3% vs. 25%, P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%, P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%, P = 0.05). CONCLUSIONS: An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.
Amputation, Surgical , Angioplasty , Endovascular Procedures , Ischemia , Leg , Limb Salvage , Peripheral Arterial Disease , Postoperative Complications , Tibial Arteries , Aged , Amputation, Surgical/methods , Amputation, Surgical/statistics & numerical data , Angioplasty/adverse effects , Angioplasty/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Female , Humans , Ischemia/diagnosis , Ischemia/etiology , Ischemia/surgery , Israel , Leg/blood supply , Leg/surgery , Limb Salvage/instrumentation , Limb Salvage/methods , Limb Salvage/statistics & numerical data , Male , Outcome and Process Assessment, Health Care , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/surgery , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , Stents , Tibial Arteries/diagnostic imaging , Tibial Arteries/physiopathology , Tibial Arteries/surgery , Vascular Patency
OBJECTIVE: Paget-Schroetter syndrome (PSS) is an uncommon disease with potentially debilitating long-term effects. The optimal therapy for PSS is unclear, and the role of surgical decompression of the thoracic outlet is still being questioned. In this study, we present long-term results of patients treated with catheter-directed thrombolysis (CDT) and anticoagulation without surgical management. METHODS: This is a retrospective case series of all patients who previously underwent treatment of PSS in our institution between the years 2007 and 2019. Patients were evaluated for clinical signs of post-thrombotic syndrome (PTS) using a modified Villalta scoring scale, including measurements of the circumference of the treated and untreated arms. Duplex ultrasound examination of the treated vein was performed, and quality of life was evaluated using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: Eighteen consecutive patients previously treated for PSS with CDT and anticoagulation compose the cohort of this study. None underwent surgical thoracic outlet decompression. All were contacted and invited for clinical and ultrasound evaluation. Follow-up was available for all patients. Mean age at diagnosis was 29 years (range, 16-46 years), and 15 (79%) were male. Mean time from the index event to the follow-up clinic visit was 109 months (range, 37-176 months). Patients were treated with anticoagulation for a mean period of 26 months (range, 6-120 months). Seventeen patients (94%) had a Villalta score of 0 to 3, consistent with nonexistence of PTS. Fourteen patients (78%) were completely asymptomatic. Seven patients (39%) had no difference in arm circumference. A difference in arm circumference between the treated arm and the healthy arm of 1 cm and 2 cm was seen in nine (50%) and two (11%) patients, respectively. Based on the shortened Disabilities of the Arm, Shoulder, and Hand score, none of the patients suffered from impaired quality of life. Duplex ultrasound scanning of the affected veins was performed on 16 of the 18 patients (89%). The vein appeared patent in all examined patients. In three patients, the wall of the examined vein was thickened and irregular. CONCLUSIONS: This study suggests that PSS patients can be treated with anticoagulation and CDT alone, without the need for surgical thoracic outlet decompression. This is based on long-term follow-up of these patients objectively evaluated by means of valid scoring systems. These findings suggest that symptoms or signs of PTS rarely develop, the patients do not suffer from impaired quality of life, and patency of the diseased vein is commonly maintained.
Anticoagulants/therapeutic use , Fibrinolytic Agents/administration & dosage , Thrombolytic Therapy , Upper Extremity Deep Vein Thrombosis/drug therapy , Adolescent , Adult , Anticoagulants/adverse effects , Databases, Factual , Disability Evaluation , Female , Fibrinolytic Agents/adverse effects , Humans , Male , Middle Aged , Postthrombotic Syndrome/epidemiology , Prevalence , Quality of Life , Recovery of Function , Recurrence , Retrospective Studies , Thrombolytic Therapy/adverse effects , Time Factors , Treatment Outcome , Ultrasonography, Doppler, Duplex , Upper Extremity Deep Vein Thrombosis/diagnostic imaging , Upper Extremity Deep Vein Thrombosis/epidemiology , Upper Extremity Deep Vein Thrombosis/physiopathology , Vascular Patency , Young Adult
OBJECTIVES: To report our early experience using endografts with inner branches for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). METHODS: A retrospective analysis of all patients treated in our institution for complex abdominal aortic aneurysms and TAAAs with custom-made stent grafts consisting of one or more inner branches. Data collected included patients demographics, aortic aneurysm morphology, stent grafts features, perioperative morbidity and mortality and short-term reintervention and mortality rates. RESULTS: Twenty-seven patients (18 males, mean age 70 ± 7.1) were included. Indications for surgery included TAAAs (12, 41%) juxtarenal abdominal aortic aneurysms (10, 37%), type 1A endoleaks (4, 15%) and paraanastamotic aneurysms (1, 4%). A total of 90 inner branches were used. Twenty-one (78%) of the stent grafts consisted only of inner branches and six (22%) had a combination of inner branches with either fenestrations or outer branches. Technical success was achieved in 26/27 (96%) of the patients. There was one perioperative mortality. Six patients suffered from major perioperative adverse events. Mean follow-up was seven months (range 1-23). During the follow-up period, four patients (15%) required reinterventions. Branch-related reinterventions were performed in two (7%) patients. No occlusions of inner branches occurred during the follow-up. CONCLUSIONS: Inner branches in branched endovascular aneurysm repairs offer a feasible option for the treatment of complex abdominal aortic aneurysms and TAAAs. The procedures can be completed with high technical success and with acceptable short-term branch-related reintervention rates. Further follow-up is required to determine the long-term durability of this technology.
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aged , Aged, 80 and over , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Databases, Factual , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Endovascular Procedures/mortality , Female , Humans , Male , Middle Aged , Postoperative Complications/therapy , Retreatment , Retrospective Studies , Stents , Time Factors , Treatment Outcome
BACKGROUND: Air travel thrombosis continues to be a controversial topic. Exposure to hypoxia and hypobaric conditions during air travel is assumed a risk factor. The aim of this study is to explore changes in parameters of coagulation, fibrinolysis and blood flow in a rat model of exposure to hypobaric conditions that imitate commercial and combat flights. METHODS: Sixty Sprague-Dawley male rats, aged 10 weeks, were divided into 5 groups according to the type and duration of exposure to hypobaric conditions. The exposure conditions were 609 m and 7620 m for 2 and 12 h duration. Blood count, thrombin- antithrombin complex, D-dimer, interleukin-1 and interleukin-6 were analyzed. All rats went through flight angiography MRI at day 13-post exposure. RESULTS: No effect of the various exposure conditions was observed on coagulation, fibrinolytic system, IL-1 or IL-6. MRI angiography showed blood flow reduction in lower limb to less than 30% in 50% of the rats. The reduction in blood flow was more pronounced in the left vessel than in the right vessel (p = 0.006, Wilcoxon signed rank test). The extent of occlusion differed across exposure groups in the right, but not the left vessel (p = 0.002, p = 0.150, respectively, Kruskal-Wallis test). However, these differences did not correlate with the exposure conditions. CONCLUSION: In the present rat model, no clear correlation between various hypobaric conditions and activation of coagulation was observed. The reduction in blood flow in the lower limb also occurred in the control group and was not related to the type of exposure.
