Vasa-european Journal of Vascular Medicine最新文献

Background: Open thoracoabdominal aortic aneurysm (TAAA) repair for Crawford extent II aneurysms carries substantial risks. This study compares outcomes of open TAAA repair following prior thoracic endovascular aortic repair (TEVAR) with conventional open extent II repair. Patients and methods: A retrospective analysis of 91 patients (2006-2024) divided into prior TEVAR (n=29) and conventional repair Crawford extent II repair without previous TEVAR (n=62). Primary endpoints included mortality and complications; secondary endpoints assessed survival and reinterventions. This study was designed according to STROBE criteria. Results: The prior TEVAR group (n=29) had a mean age of 61.5±10.7 years and 72.4% were male, while the conventional extent II repair group (n=62) had a mean age of 63.2±9.8 years and 69.4% were male. Prior TEVAR patients underwent open repair for extent II (13.8%), III (58.6%), or IV (27.6%) aneurysms. In-hospital mortality was lower in the prior TEVAR group (6.9% vs. 25.8%, p =.07), as were rates of spinal cord ischemia (3.4% vs. 8.1%, p =.55), acute kidney injury (24.1% vs. 35.5%, p =.28), and massive transfusion (24.1% vs. 30.6%, p =.54). Pulmonary complications occurred less frequently after TEVAR (69.0% vs. 82.3%, p =.25). Kaplan-Meier analysis revealed no significant survival difference (log-rank p=.05), with 5-year survival rates of 94% (prior TEVAR) and 61% (conventional). Aortic reintervention rates were also similar (10.5% vs. 18.8%, p=.69). Conclusions: Open TAAA repair following prior TEVAR may offer clinically meaningful advantages over conventional open type II repair with acceptable survival rates; however, these findings should be interpreted cautiously given the study's retrospective design and small sample size. Staged hybrid approach could be a viable strategy for managing complex aortic pathologies.

Background: Type II endoleaks (T2EL) remain the most common complication after endovascular aneurysm repair (EVAR). Aneurysm sac regression is a predictor for better treatment outcomes compared to sac stability and growth. T2EL are associated with aneurysm sac regression and prophylactic embolization of the sac or side branches may result in lower T2EL incidence. This review aims to assess the current evidence on whether prophylactic treatment strategies provide improved clinical outcomes after EVAR. Materials and methods: A systematic search was performed of the Scopus, PubMed and Web of Science databases. Original studies reporting prophylactic embolization to prevent endoleaks were included and a meta-analysis was performed on important clinical outcome parameters; T2EL incidence, sac remodelling and T2EL related reinterventions. Results: A total of 1,870 publications were identified. After screening and quality assessment by two reviewers, data were extracted from 29 studies and analysed. T2EL incidence was significantly lower in the embolization group; odds ratio 0.29 [0.19-0.45, 95% confidence interval] at 6 months, 0.20 [0.13-0.31] at 12 months and 0.28 [0.14-0.55] at 24 months. Sac growth was significantly lower in the embolization group with odds ratios of 0.08 [0.01-0.59], 0.16 [0.05-0.53] and 0.24 [0.11-0.52] at 6, 12 and 24 months, respectively. Sac shrinkage was significantly higher in the embolization group with odds ratios of 0.42 [0.28-0.63], 0.49 [0.32-0.77] and 0.28 [0.16-0.50] at 6, 12 and 24 months, respectively. Reintervention rates were lower in the embolization group, although not statistically significant. Conclusions: The results from this review and meta-analysis show that prophylactic embolization, either through non-selective sac filling or selective side branch embolization, result in better clinical outcomes at 6, 12 and 24 months. Prophylactic embolization seems promising in increasing sac regression rates and reducing T2EL incidence, but more data about other clinical outcome parameters is required.

Background: Endovascular aortic aneurysm repair (EVAR) has evolved into a widely established alternative to traditional open surgical repair. For EVAR procedures, both mobile (standard operating room (SOR)) and fixed C-arm (hybrid operating room (HOR) systems are available. The aim of our study was to evaluate the advantages of implementing a HOR for endovascular aortic aneurysm repair at a new vascular surgery centre. Materials and methods: Between April 2020 and December 2024, data of 140 patients who treated endovascularly for aortic aneurysms (AAs) were retrospectively evaluated. In detail, between April 2020 and March 2023, in 43 consecutive cases a mobile C-arm device was used, compared to the second period from April 2023 up to December 2024 when 97 consecutive patients with AAs were treated in a HOR. Primary endpoints of the study were procedural duration, radiation exposure time, and radiation dose. Results: Radiation exposure was significantly lower in the HOR group, with median radiation time of 15.3 vs. 23.1 minutes and median dose of 7.9 vs. 13.5 Gy·cm² (p<.001). The EVAR radiation time (14.1 vs. 20.6 minutes) and dose (6.6 vs. 11.4 Gy·cm²) remained significantly lower in the HOR group (p<.001). The implementation of the HOR was associated with a 125% increase of treated cases, resulting in a nearly four-fold rise of the total monthly case volume compared to the first period with the mobile C-arm. Discussion: The results of our study highlight the advantages of the HOR, such as reduced radiation, improved workflow efficiency and greater procedural capacity. Conclusions: Newly founded vascular centres should consider incorporating a HOR at the earliest opportunity.

Background: The benefit-risk profile of thoracic endovascular aortic repair (TEVAR) in patients with type B aortic intramural hematoma (IMH) has not been well established yet. This study aimed to evaluate the outcomes of TEVAR compared with medical management (MM) in this population. Patients and methods: PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing TEVAR with MM in patients with type B IMH. Results: Sixteen studies involving 1528 patients were included in this meta-analysis. Compared with the MM group, the TEVAR group displayed similar incidences of in-hospital death [RR (95%CI): 0.73 (0.32-1.66), p=.45] and aortic-related death [RR (95%CI): 0.70 (0.31-1.58]), p=.39]. The risk of all-cause death was comparable between the two groups [RR (95%CI): 0.62 (0.36-1.07), p=.08]. Meanwhile, TEVAR was superior to MM in promoting IMH regression [RR (95%CI): 1.51(1.26-1.81), p<.001] and reducing IMH progression [RR (95%CI): 0.15 (0.08-0.29), p<.001], dissection [RR (95%CI): 0.26 (0.12-0.60), p=.002], and secondary intervention [RR (95%CI): 0.22 (0.08-0.60), p=.003]. Conclusions: In patients with type B IMH, the incidences of in-hospital death, aortic-related death and all-cause death during follow-up were comparable between the TEVAR group and the MM group. However, TEVAR was superior to MM in promoting IMH regression and reducing IMH progression, dissection, and secondary intervention. Further randomized controlled trials are needed to clarify the role of TEVAR in this population.

Background: Thoracic endovascular aortic repair (TEVAR) involving the left subclavian artery (Ishimaru zone 2) presents technical challenges. This multicentre study evaluates the Ankura thoracic stent graft with in-situ fenestration using a dedicated needle system (Lifetech, Shenzhen, China) for various thoracic aortic pathologies. Patients and methods: Between January 2020 and December 2025, 59 patients from three tertiary centres underwent in-situ fenestration TEVAR (if-TEVAR) for thoracoabdominal aortic pathologies. Clinical and imaging data were analysed, focusing on technical success, complications, and mid-term outcomes. Results: Demographics and comorbidities were comparable across pathologies. The SVS/AAVS age score was higher in TAAA and PAU patients (p=.005). Dissection cases required more grafts (p=.027), larger proximal diameters (p=.022), and showed less distal oversizing in TAAA (p=.031). Differences were noted in fenestration time (p=.049), stent type (p=.032), and adjunctive procedures (p<.001). Technical success was 93.2% (55/59), with no significant variation among groups. One patient died within 30 days (2% mortality). ICU/hospital stays and complications were similar. Conclusions: if-TEVAR with the Ankura graft in zone 2 is feasible with acceptable outcomes. Larger studies with extended follow-up are needed to confirm durability.

Background: To evaluate the short-term outcomes of a novel, customized multibranched G-Branch endograft for the treatment of thoraco-abdominal aortic aneurysm (TAAA) and juxta/pararenal abdominal aortic aneurysm (J/PAAA). Patients and methods: Between July 2023 and May 2025, 50 patients (mean age 72 years; 45 men) were treated with implantation of a customized G-Branch endograft (Lifetech Scientific, Shenzhen, China) at four European regional vascular centres. The mean aneurysm diameter was 65.7 mm (range, 55-90 mm). Depending on the size and extent of the aortic pathology, 19 patients had J/PAAA and 31 had TAAA. Three patients had concomitant common iliac artery aneurysms, and one patient had a concomitant arch aneurysm. All patients underwent either an elective one-stage repair (30 patients, 60%) or a staged repair (20 patients, 40%) according to the local protocol of each centre. Multicentre outcome data were prospectively collected and retrospectively analysed. Perioperative results were assessed before discharge and during follow-ups at 1, 6, and 12 months. Results: Technical success was achieved in 96% (48/50) of patients. In-hospital mortality was 4% (2/50). Early perioperative complications occurred in six patients (11%), with no spinal cord ischemia. Over a mean follow-up of 7 months (range, 1-23 months), two patient (4%) required an unplanned late reintervention with branch extension or relining due to a type Ic and IIIb endoleaks, respectively. Of the 198 target vessels, all remained patent, yielding an overall freedom from branch instability of 99%. No patients died due to aneurysm- or procedure-related causes; one patient died 8 months postoperatively due to a major stroke. All remaining 47 patients were doing well at the last follow-up. Conclusions: Our preliminary experience with the G-Branch endograft appears safe and yields high technical success with encouraging short-term outcomes for the endovascular repair of J/PAAA and TAAA. Continued patient surveillance and extended follow-up are essential to confirm these results.

Background: Acute abdominal aortic occlusion is a rare vascular emergency associated with high morbidity and mortality. To date, the topic has hardly been addressed scientifically. Most case series are afflicted with small cohort numbers. The aim of this study was to identify risk factors after invasive treatment of acute abdominal aortic occlusion and changes over time. Patients and methods: Using case-based nationwide hospital statistics (diagnosis-related group [DRG] statistics) from 2009 to 2020, all cases with ICD-10 codes for embolism and thrombosis of the abdominal aorta in conjunction with acute limb ischaemia and consecutive invasive treatment (endovascular or open surgery) were included. The analysis included patient characteristics, treatment, mortality, amputation, and complications. The primary outcome was in-hospital death. A multivariable regression model was applied to detect risk factors. Results: A total of 1160 cases (66% male) with acute abdominal aortic occlusion were identified (941 open; 219 endovascular). Between 2009 and 2020, the rate of endovascular treatments (2010: 6%; 2020: 29%; p<.001) increased significantly over the years. Older patients (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.64-0.9, p=.002) and women (OR 0.65; 95% CI 0.48-0.88, p=.006) were more likely to receive endovascular care. In-hospital mortality was 13% after open surgery and 14% after endovascular treatment, with no significant change in open surgery, but high variability in endovascular treatment during the observation period (2009-2011: open 14%; endovascular 25%; 2018-2020: 10%; 11%). In-hospital mortality increased significantly with higher age (OR 2.19 per 10-year increase; 95% CI 1.79-2.7, p<.001) and comorbidities (OR 1.1 per Elixhauser point; 95% 1.07-1.11, p<.001). Conclusions: Acute aortic occlusion remains a rare but life-threatening emergency. Use of endovascular revascularization techniques is increasing, while in-hospital mortality rates remain high, specifically for older and morbid patients.

Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Unplanned rehospitalisation rates after discharge remain high, reflecting the chronic nature of CVD and the frequent need for complex, multidisciplinary follow-up care. Digital interventions may provide a valuable complement to traditional discharge management in addressing these challenges. Patients and methods: This study aims to assess the acceptance of digital discharge management interventions (DDMI) and to investigate the underlying factors influencing acceptance among patients with CVD following inpatient treatment. A cross-sectional survey-based study was conducted from June to October 2024 with N = 259 patients with CVD following inpatient treatment. Sociodemographic, medical, mental health, and e-Health-related data were assessed. Acceptance of DDMI and its underlying factors were assessed using a modified model of the Unified Theory of Acceptance of Use of Technology (UTAUT). Results: The overall acceptance of DDMI was high (M = 3.99, SD = 0.92, range = 1-5). The extended UTAUT model explained 62.7% of the variance in acceptance, with male gender (β = -0.36, p < .001) and the UTAUT predictors effort expectancy (β = 0.40, p < .001), performance expectancy (β = 0.24, p < .001), and social influence (β = 0.20, p < .001) being significant predictors. Conclusions: These findings indicate a generally high acceptance of DDMI among patients with CVD following inpatient treatment. To develop and implement such interventions, key drivers and barriers such as effort expectancy, performance expectancy, and social influence should be addressed. Furthermore, such interventions should be tailored to patients' specific needs.