Pub Date : 2025-01-01Epub Date: 2025-04-30DOI: 10.4103/vit.vit_2_25
Cayetana Lazcano-Etchebarne, Edouard Aboian, David Strosberg, Nirvana Sadaghianloo, Andrew W Schwartz, Bryan Ho, Yuichi Ohashi, Masaki Kano, Luis Gonzalez, Hualong Bai, Alan Dardik
Arteriovenous fistulae (AVF) are the gold standard for vascular access among patients requiring hemodialysis; however, AVF have high primary failure rates. Novel approaches and technologies to improve AVF patency include modifications to open approaches, such as the radial artery deviation and reimplantation fistula, and percutaneous approaches, such as the endovascular AVF. Despite these advances, these modifications are limited in reducing neointimal hyperplasia, stenosis, or thrombosis, and thus have limited capacity to improve AVF maturation and utilization; as such, vascular access requires continued innovation. Emerging strategies to prevent neointimal hyperplasia include drug-embedded and bioresorbable perivascular wraps. Increased rates of AVF failure among women highlight sex differences in the biology of AVF maturation and suggest additional targets to improve outcomes. Other advances in understanding the biology of AVF maturation suggest potentialized approaches for patients, including immune system modulation and stem cell therapies. Although these emerging technologies may improve AVF maturation and utilization, longer-term patency and freedom from complications such as central vein stenosis and dialysis access associated distal ischemia emphasize the critical need for continued scientific inquiry and technological development to optimize vascular access.
{"title":"Recent Innovations and Advances in Arteriovenous Fistula Creation: A Narrative Review.","authors":"Cayetana Lazcano-Etchebarne, Edouard Aboian, David Strosberg, Nirvana Sadaghianloo, Andrew W Schwartz, Bryan Ho, Yuichi Ohashi, Masaki Kano, Luis Gonzalez, Hualong Bai, Alan Dardik","doi":"10.4103/vit.vit_2_25","DOIUrl":"10.4103/vit.vit_2_25","url":null,"abstract":"<p><p>Arteriovenous fistulae (AVF) are the gold standard for vascular access among patients requiring hemodialysis; however, AVF have high primary failure rates. Novel approaches and technologies to improve AVF patency include modifications to open approaches, such as the radial artery deviation and reimplantation fistula, and percutaneous approaches, such as the endovascular AVF. Despite these advances, these modifications are limited in reducing neointimal hyperplasia, stenosis, or thrombosis, and thus have limited capacity to improve AVF maturation and utilization; as such, vascular access requires continued innovation. Emerging strategies to prevent neointimal hyperplasia include drug-embedded and bioresorbable perivascular wraps. Increased rates of AVF failure among women highlight sex differences in the biology of AVF maturation and suggest additional targets to improve outcomes. Other advances in understanding the biology of AVF maturation suggest potentialized approaches for patients, including immune system modulation and stem cell therapies. Although these emerging technologies may improve AVF maturation and utilization, longer-term patency and freedom from complications such as central vein stenosis and dialysis access associated distal ischemia emphasize the critical need for continued scientific inquiry and technological development to optimize vascular access.</p>","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"8 1","pages":"7-17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiatang Xu, Lin Cao, Minyi Huang, Xianghui Luo, Tianhong Chen, Kai Huang, Chen Yao
CONTEXT: Closure rate of endovenous thermal ablation is limited by the trunk diameter of great saphenous vein. AIMS: This study aimed to investigate the safety and efficacy of transluminal injection of foam sclerotherapy (TLFS) after thermal ablation in improving the closure rate of primary varicose veins with large trunk. SUBJECTS AND METHODS: In this retrospective cohort study with 170 patients (189 legs), the outcomes of varicose veins patients treated with thermal ablation plus injection of sclerotherapy were compared with those treated with thermal ablation only. The primary outcome of this study was the rate of ablated segment closure after surgery and during patient follow-up. Propensity score matching model was used to eliminate the bias. RESULTS: After matching, 75 legs (65 patients) from the thermal ablation plus sclerotherapy group and 71 legs (66 patients) from the thermal ablation only group were further analyzed. The closure rate of the thermal ablation plus sclerotherapy group was 97.3%, which was significantly higher than that of the thermal ablation only group (87.3%, P = 0.048), and the closure rate of the thermal ablation plus sclerotherapy group remained higher during 1-year follow-up. No serious complications were observed in groups. CONCLUSIONS: TLFS can improve the efficacy of thermal ablation, increasing the closure rate of the ablation segment, and thus improving the symptoms.
{"title":"The safety and efficacy of transluminal injection of foam sclerotherapy after endovenous thermal ablation in varicose veins with large trunk: A retrospective cohort study","authors":"Jiatang Xu, Lin Cao, Minyi Huang, Xianghui Luo, Tianhong Chen, Kai Huang, Chen Yao","doi":"10.4103/vit.vit_13_23","DOIUrl":"https://doi.org/10.4103/vit.vit_13_23","url":null,"abstract":"CONTEXT: Closure rate of endovenous thermal ablation is limited by the trunk diameter of great saphenous vein. AIMS: This study aimed to investigate the safety and efficacy of transluminal injection of foam sclerotherapy (TLFS) after thermal ablation in improving the closure rate of primary varicose veins with large trunk. SUBJECTS AND METHODS: In this retrospective cohort study with 170 patients (189 legs), the outcomes of varicose veins patients treated with thermal ablation plus injection of sclerotherapy were compared with those treated with thermal ablation only. The primary outcome of this study was the rate of ablated segment closure after surgery and during patient follow-up. Propensity score matching model was used to eliminate the bias. RESULTS: After matching, 75 legs (65 patients) from the thermal ablation plus sclerotherapy group and 71 legs (66 patients) from the thermal ablation only group were further analyzed. The closure rate of the thermal ablation plus sclerotherapy group was 97.3%, which was significantly higher than that of the thermal ablation only group (87.3%, P = 0.048), and the closure rate of the thermal ablation plus sclerotherapy group remained higher during 1-year follow-up. No serious complications were observed in groups. CONCLUSIONS: TLFS can improve the efficacy of thermal ablation, increasing the closure rate of the ablation segment, and thus improving the symptoms.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"13 1","pages":"79 - 85"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steep aortic arch (such as Type III arch) and small angle between the chimney artery and aortic arch are two anatomic conditions suitable for chimney grafts (CGs). The more the number of chimneys, the higher the incidence of endoleak and branch occlusion; thus, the triple-chimney technique should be avoided unless the lesion involves zone 0 and no other better option is available, or a pending rupture is present and requires emergent repair. For the oversize of multiple chimneys, we suggest that the aortic stent and chimney stent should be increased by 5%, respectively, on the basis of single chimney. Moreover, the direction of the chimney stent is decided by the relative position of the proximal tear in patients with dissection. When the tear is located in the anterior segment, the chimney graft should be deployed behind the aortic stent graft, close to the posterior wall of the thoracic aorta, and in front of the aortic stent grafts when the tear is located in the posterior segment. In conclusion, if the endoleak is small and the patient's condition is stable with no obvious discomfort, for most of the patients, the endoleak will disappear spontaneously in the follow-up. If the endoleak is large, microcoil could be implanted through the narrow and long gap to block the endoleak under the guidance of ultrasound. CGs technique needs to be scrutinized continuously as new data emerge. Special configurations of aortic and chimney endograft need to be developed to better treat aortic pathologies involving supra-arch branches.
陡峭的主动脉弓（如 III 型弓）和烟囱动脉与主动脉弓之间的小角度是适合烟囱移植（CG）的两种解剖条件。烟囱数量越多，内漏和分支闭塞的发生率就越高；因此，应避免使用三烟囱技术，除非病变涉及 0 区且没有其他更好的选择，或者存在未决破裂，需要紧急修复。对于多烟囱的超大尺寸，我们建议主动脉支架和烟囱支架应在单烟囱的基础上分别增加 5%。此外，烟囱支架的方向取决于夹层患者近端撕裂的相对位置。当撕裂位于前段时，烟囱支架应部署在主动脉支架移植物的后面，靠近胸主动脉后壁；当撕裂位于后段时，烟囱支架应部署在主动脉支架移植物的前面。总之，如果内漏较小，且患者病情稳定，无明显不适，大多数患者的内漏会在随访中自然消失。如果内漏较大，可在超声引导下，通过狭长的间隙植入微线圈堵塞内漏。随着新数据的不断涌现，CGs 技术也需要不断完善。还需要开发特殊结构的主动脉和烟囱内植物，以更好地治疗涉及拱上分支的主动脉病变。
{"title":"The evidence of chimney grafts in treating aortic arch diseases","authors":"Yan-qing Chen, Qingsheng Lu","doi":"10.4103/vit.vit_9_23","DOIUrl":"https://doi.org/10.4103/vit.vit_9_23","url":null,"abstract":"Steep aortic arch (such as Type III arch) and small angle between the chimney artery and aortic arch are two anatomic conditions suitable for chimney grafts (CGs). The more the number of chimneys, the higher the incidence of endoleak and branch occlusion; thus, the triple-chimney technique should be avoided unless the lesion involves zone 0 and no other better option is available, or a pending rupture is present and requires emergent repair. For the oversize of multiple chimneys, we suggest that the aortic stent and chimney stent should be increased by 5%, respectively, on the basis of single chimney. Moreover, the direction of the chimney stent is decided by the relative position of the proximal tear in patients with dissection. When the tear is located in the anterior segment, the chimney graft should be deployed behind the aortic stent graft, close to the posterior wall of the thoracic aorta, and in front of the aortic stent grafts when the tear is located in the posterior segment. In conclusion, if the endoleak is small and the patient's condition is stable with no obvious discomfort, for most of the patients, the endoleak will disappear spontaneously in the follow-up. If the endoleak is large, microcoil could be implanted through the narrow and long gap to block the endoleak under the guidance of ultrasound. CGs technique needs to be scrutinized continuously as new data emerge. Special configurations of aortic and chimney endograft need to be developed to better treat aortic pathologies involving supra-arch branches.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"1 1","pages":"55 - 59"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/2589-9686.389887
Yunchong Liu, Weibin Wu, R. Wu, Mian Wang, G. Chang, C. Yao, Zi-lun Li
OBJECTIVES: Aortic dissection with aberrant right subclavian artery (ARSA) is rare but fatal, with its optimal treatment remaining controversial. In this retrospective study, we presented the outcome of endovascular repair for these patients, aiming to evaluate the efficacy and safety of this technique. MATERIALS AND METHODS: From January 2016 to January 2022, seven patients diagnosed with aortic dissection with ARSA in the First Affiliated Hospital of Sun Yat-sen University were enrolled. All these seven patients received thoracic endovascular aortic repair (TEVAR) within 1 week after their admission to our center. The data of baseline characteristics, imaging parameters, perioperative information, and follow-up were collected till March 2023. RESULTS: The mean age was 48.57 ± 9.41 years. Kommerell diverticulum was found in 2 (28.6%) patients. Among these seven patients, 4 (57.1%) were treated by TEVAR + branched stent graft + chimney technique, 2 (28.6%) were treated by TEVAR + chimney technique, and 1 (14.3%) was treated by TEVAR + chimney and periscope techniques. The mean time of procedures was 196.67 ± 31.18 min. Clinical success was achieved in 6 (85.7%) patients, while 1 (14.3%) patient died of nonaortic related cause. Bird beak configuration was discovered in 4 (57.1%) patients with an average length of 17.87 ± 3.93 mm and angle of 21.9° ±3.70°. One early type I endoleak and one mild cerebral ischemia were discovered, and recovered spontaneously before discharge. The diameter of the aorta remained stable, and no complication was found during the follow-up of the six patients. CONCLUSION: Endovascular repair of aortic dissection with ARSA was feasible and safe, with a favorable early to mid-term outcome.
{"title":"A retrospective study of endovascular repair of aortic dissection with aberrant right subclavian artery","authors":"Yunchong Liu, Weibin Wu, R. Wu, Mian Wang, G. Chang, C. Yao, Zi-lun Li","doi":"10.4103/2589-9686.389887","DOIUrl":"https://doi.org/10.4103/2589-9686.389887","url":null,"abstract":"OBJECTIVES: Aortic dissection with aberrant right subclavian artery (ARSA) is rare but fatal, with its optimal treatment remaining controversial. In this retrospective study, we presented the outcome of endovascular repair for these patients, aiming to evaluate the efficacy and safety of this technique. MATERIALS AND METHODS: From January 2016 to January 2022, seven patients diagnosed with aortic dissection with ARSA in the First Affiliated Hospital of Sun Yat-sen University were enrolled. All these seven patients received thoracic endovascular aortic repair (TEVAR) within 1 week after their admission to our center. The data of baseline characteristics, imaging parameters, perioperative information, and follow-up were collected till March 2023. RESULTS: The mean age was 48.57 ± 9.41 years. Kommerell diverticulum was found in 2 (28.6%) patients. Among these seven patients, 4 (57.1%) were treated by TEVAR + branched stent graft + chimney technique, 2 (28.6%) were treated by TEVAR + chimney technique, and 1 (14.3%) was treated by TEVAR + chimney and periscope techniques. The mean time of procedures was 196.67 ± 31.18 min. Clinical success was achieved in 6 (85.7%) patients, while 1 (14.3%) patient died of nonaortic related cause. Bird beak configuration was discovered in 4 (57.1%) patients with an average length of 17.87 ± 3.93 mm and angle of 21.9° ±3.70°. One early type I endoleak and one mild cerebral ischemia were discovered, and recovered spontaneously before discharge. The diameter of the aorta remained stable, and no complication was found during the follow-up of the six patients. CONCLUSION: Endovascular repair of aortic dissection with ARSA was feasible and safe, with a favorable early to mid-term outcome.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"37 1","pages":"74 - 78"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessment of the carotid atherosclerosis disease can give a prognostication of a patient's cardiovascular risk. The assessment of carotid atherosclerosis is essential because of the complication of risk factors resulting in severe cardiovascular disease (CVD). This review article aims to summarize systematically the pathophysiology, followed by diagnostic assessment and therapeutic uses of imaging and treatment for carotid atherosclerosis disease. Duplex ultrasound (DUS) of the carotid artery, transcranial Doppler imaging, computed tomographic angiography (CTA), magnetic resonance angiography, and cerebral digital subtraction angiography are diagnostic techniques for carotid stenosis. Currently, DUS of the carotid arteries is the primary screening method for carotid stenosis. Recent interest has focused on carotid intima-media thickness measurements as a possible indicator of early-stage carotid atherosclerosis or CVD risk prediction. Through the growing fields of stress tests and carotid plaque screening, the classification of cardiovascular risk may be improved.
对颈动脉粥样硬化疾病的评估可以预示患者的心血管风险。颈动脉粥样硬化是导致严重心血管疾病（CVD）的危险因素，因此评估颈动脉粥样硬化至关重要。这篇综述文章旨在系统地总结颈动脉粥样硬化疾病的病理生理学、诊断评估、影像学和治疗方法。颈动脉双功超声（DUS）、经颅多普勒成像、计算机断层扫描血管造影（CTA）、磁共振血管造影和脑数字减影血管造影是颈动脉狭窄的诊断技术。目前，颈动脉 DUS 是颈动脉狭窄的主要筛查方法。最近，人们开始关注颈动脉内膜中层厚度测量，将其作为早期颈动脉粥样硬化或心血管疾病风险预测的可能指标。通过不断发展的压力测试和颈动脉斑块筛查领域，心血管风险的分类可能会得到改善。
{"title":"Assessment of carotid atherosclerosis disease as an incremental predictive value for cardiovascular disease risk","authors":"Sidhi Laksono, Hillary Kusharsamita","doi":"10.4103/vit.vit_12_23","DOIUrl":"https://doi.org/10.4103/vit.vit_12_23","url":null,"abstract":"Assessment of the carotid atherosclerosis disease can give a prognostication of a patient's cardiovascular risk. The assessment of carotid atherosclerosis is essential because of the complication of risk factors resulting in severe cardiovascular disease (CVD). This review article aims to summarize systematically the pathophysiology, followed by diagnostic assessment and therapeutic uses of imaging and treatment for carotid atherosclerosis disease. Duplex ultrasound (DUS) of the carotid artery, transcranial Doppler imaging, computed tomographic angiography (CTA), magnetic resonance angiography, and cerebral digital subtraction angiography are diagnostic techniques for carotid stenosis. Currently, DUS of the carotid arteries is the primary screening method for carotid stenosis. Recent interest has focused on carotid intima-media thickness measurements as a possible indicator of early-stage carotid atherosclerosis or CVD risk prediction. Through the growing fields of stress tests and carotid plaque screening, the classification of cardiovascular risk may be improved.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"34 1","pages":"60 - 66"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/2589-9686.389883
Yunfeng Pang, Kailong Li, Xiaoqin Li, Yang Jin, Hao Cai, Fei Shao, Guodong Wang, Chong Ma, Gehua Wen, Ziqiang Sun, Song Jin
OBJECTIVE: May–Thurner syndrome (MTS) is a common cause of lower-extremity deep venous thrombosis (DVT). Stenting is effective in the treatment of MTS; however, there are still complications that may affect the patency of the stent. In addition, the long-term efficacy of stenting remains uncertain. This retrospective study investigated the efficacy and prognosis of endovascular treatment of acute proximal DVT with MTS. MATERIALS AND METHODS: Between June 2014 and December 2017, 122 patients with acute symptomatic proximal DVT at our hospital underwent endovascular surgery. The clinical data of the patients were retrospectively collected including follow-up information. The analysis used the generalized additive mixed model and Kaplan–Meier curves (log-rank test). RESULTS: Of the 122 patients, 75 underwent only catheter-directed thrombolysis (CDT), and 47 underwent CDT with stent placement. Characteristics such as age (P = 0.630 ) and gender (P = 0.842) did not show significant differences between the two groups. The freedom from target lesion revascularization did not show significant differences between the two groups (P = 0.82). There were no significant differences between the two groups in the Venous Clinical Severity Score and Villalta Score. CONCLUSIONS: Endovascular treatment of acute lower limb DVT with MTS has good overall efficacy. In young patients with DVT caused by multiple factors besides MTS, prolonged anticoagulation and close follow-up may be more appropriate than primary stenting after thrombus clearance and significant relief of lower limb symptoms.
{"title":"Long-term outcomes of endovascular treatment of acute lower limb deep-vein thrombosis combined with May–Thurner syndrome: A single-center retrospective cohort study","authors":"Yunfeng Pang, Kailong Li, Xiaoqin Li, Yang Jin, Hao Cai, Fei Shao, Guodong Wang, Chong Ma, Gehua Wen, Ziqiang Sun, Song Jin","doi":"10.4103/2589-9686.389883","DOIUrl":"https://doi.org/10.4103/2589-9686.389883","url":null,"abstract":"OBJECTIVE: May–Thurner syndrome (MTS) is a common cause of lower-extremity deep venous thrombosis (DVT). Stenting is effective in the treatment of MTS; however, there are still complications that may affect the patency of the stent. In addition, the long-term efficacy of stenting remains uncertain. This retrospective study investigated the efficacy and prognosis of endovascular treatment of acute proximal DVT with MTS. MATERIALS AND METHODS: Between June 2014 and December 2017, 122 patients with acute symptomatic proximal DVT at our hospital underwent endovascular surgery. The clinical data of the patients were retrospectively collected including follow-up information. The analysis used the generalized additive mixed model and Kaplan–Meier curves (log-rank test). RESULTS: Of the 122 patients, 75 underwent only catheter-directed thrombolysis (CDT), and 47 underwent CDT with stent placement. Characteristics such as age (P = 0.630 ) and gender (P = 0.842) did not show significant differences between the two groups. The freedom from target lesion revascularization did not show significant differences between the two groups (P = 0.82). There were no significant differences between the two groups in the Venous Clinical Severity Score and Villalta Score. CONCLUSIONS: Endovascular treatment of acute lower limb DVT with MTS has good overall efficacy. In young patients with DVT caused by multiple factors besides MTS, prolonged anticoagulation and close follow-up may be more appropriate than primary stenting after thrombus clearance and significant relief of lower limb symptoms.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"429 1","pages":"67 - 73"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE: The objective is to explore the correlation between carotid artery calcification score and cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS) in patients with carotid artery stenosis. METHODS: Consecutive patients treated for carotid artery stenosis from October 2016 to August 2021 from two centers were studied. Carotid artery calcification score was manually segmented on multi-detector row spiral computed tomography angiography scans before CAS. The associations between carotid artery calcification score and the occurrence of CHS during the in-hospital time were assessed. RESULTS: A total of 175 patients were enrolled in the study. The mean age was 72.12 ± 7.51 years. All patients were undergone CAS treatment successfully. There were 46 cases that occurred CHS (26.29%). Univariate logistic regression analyses showed that for every 1 unit (100-score) increase in carotid artery calcification score, the risk of CHS increased by 1937% (odds ratio [OR] = 20.37, 95% confidence interval [CI]: 7.54–55.03, P < 0.01). In addition, the increasing rate was significantly different between the open-cell group (OR = 261.7, P < 0.01) and the closed-cell group (OR = 11.4, P < 0.01). The area under curve of predictiong model of carotid artery calcification score to CHS was 0.84 (95% CI, 0.75–0.93). CONCLUSION: Carotid artery calcification score was an independent risk factor for CHS in patients who underwent CAS. The application of carotid artery calcification score as risk factor in clinical screening of carotid artery stenosis patients may have beneficial effects on the management of CAS.
目的:探讨颈动脉狭窄患者颈动脉支架植入术(CAS)后颈动脉钙化评分与脑高灌注综合征(CHS)的相关性。方法:研究两个中心2016年10月至2021年8月连续接受颈动脉狭窄治疗的患者。颈动脉钙化评分手工分割多探测器行螺旋ct血管造影扫描。评估颈动脉钙化评分与住院期间CHS发生的关系。结果:共有175名患者入组。平均年龄72.12±7.51岁。所有患者均成功接受CAS治疗。发生CHS 46例(26.29%)。单因素logistic回归分析显示，颈动脉钙化评分每增加1个单位(100分)，发生CHS的风险增加1937%(优势比[OR] = 20.37, 95%可信区间[CI]: 7.54 ~ 55.03, P < 0.01)。另外，开放细胞组与封闭细胞组之间的增加率差异有统计学意义(OR = 261.7, P < 0.01)，差异有统计学意义(OR = 11.4, P < 0.01)。颈动脉钙化评分对CHS的预测模型曲线下面积为0.84 (95% CI, 0.75 ~ 0.93)。结论:颈动脉钙化评分是行CAS患者发生CHS的独立危险因素。应用颈动脉钙化评分作为临床筛查颈动脉狭窄患者的危险因素，可能对CAS的治疗有有益的影响。
{"title":"Carotid artery calcification score is associated with the occurrence of cerebral hyperperfusion syndrome after carotid artery stenting","authors":"Yinxing Fan, Chaochen Wang, Xinxin Fan, Dihao Wen, Xiao-long Wei, Jiang Zhu, Shiying Wang, Jiqing Ma, Yu Li, Xiatian Zhu, Q. Lu, Zhiqing Zhao, Yudong Sun","doi":"10.4103/2589-9686.379841","DOIUrl":"https://doi.org/10.4103/2589-9686.379841","url":null,"abstract":"OBJECTIVE: The objective is to explore the correlation between carotid artery calcification score and cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS) in patients with carotid artery stenosis. METHODS: Consecutive patients treated for carotid artery stenosis from October 2016 to August 2021 from two centers were studied. Carotid artery calcification score was manually segmented on multi-detector row spiral computed tomography angiography scans before CAS. The associations between carotid artery calcification score and the occurrence of CHS during the in-hospital time were assessed. RESULTS: A total of 175 patients were enrolled in the study. The mean age was 72.12 ± 7.51 years. All patients were undergone CAS treatment successfully. There were 46 cases that occurred CHS (26.29%). Univariate logistic regression analyses showed that for every 1 unit (100-score) increase in carotid artery calcification score, the risk of CHS increased by 1937% (odds ratio [OR] = 20.37, 95% confidence interval [CI]: 7.54–55.03, P < 0.01). In addition, the increasing rate was significantly different between the open-cell group (OR = 261.7, P < 0.01) and the closed-cell group (OR = 11.4, P < 0.01). The area under curve of predictiong model of carotid artery calcification score to CHS was 0.84 (95% CI, 0.75–0.93). CONCLUSION: Carotid artery calcification score was an independent risk factor for CHS in patients who underwent CAS. The application of carotid artery calcification score as risk factor in clinical screening of carotid artery stenosis patients may have beneficial effects on the management of CAS.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"57 1","pages":"45 - 51"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81021322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/2589-9686.379842
Andrew N. Nicolaides, M. Griffin
In recent times, it has been recognized that atherosclerotic cardiovascular disease (ASCVD) risk stratification using algorithms such as Framingham risk score, prospective cardiovascular Munster, QRISK2 or SCORE2/SCORE2-OP which are based on conventional risk factors could be improved by ultrasound arterial scanning. In the past, much emphasis was placed on intima-media thickness (IMT), but two recent meta-analyses have demonstrated that IMT provides only a marginal improvement on risk factors. In contrast to IMT, the presence, thickness, area or volume of plaques at the carotid and/or common femoral bifurcations are the stronger independent predictors of future ASCVD events than conventional risk factors alone. A recent study has shown that the number of bifurcations with plaque, total plaque thickness (sum of thickness of larger plaque in each bifurcation), and total plaque area (sum of areas of all plaques present in four bifurcations) have a similar net reclassification improvement of 16.1%–16.7%. In addition to this, previous studies demonstrated that common femoral bifurcation plaques are the stronger predictors of risk than carotid plaques. Thus, as far as screening is concerned, it appears that the number of bifurcations with plaque would be sufficient. However, for clinical monitoring of the effect of therapy on plaque progression or regression, measurements of plaque area or volume are the most appropriate. The commercial availability of three-dimensional-probes for superficial vessels will now make measurements of plaque volume relatively easy and the ability to monitor plaque volume changes in a clinical setting possible.
{"title":"The contribution of arterial ultrasound scanning to atherosclerotic cardiovascular risk stratification: Short review","authors":"Andrew N. Nicolaides, M. Griffin","doi":"10.4103/2589-9686.379842","DOIUrl":"https://doi.org/10.4103/2589-9686.379842","url":null,"abstract":"In recent times, it has been recognized that atherosclerotic cardiovascular disease (ASCVD) risk stratification using algorithms such as Framingham risk score, prospective cardiovascular Munster, QRISK2 or SCORE2/SCORE2-OP which are based on conventional risk factors could be improved by ultrasound arterial scanning. In the past, much emphasis was placed on intima-media thickness (IMT), but two recent meta-analyses have demonstrated that IMT provides only a marginal improvement on risk factors. In contrast to IMT, the presence, thickness, area or volume of plaques at the carotid and/or common femoral bifurcations are the stronger independent predictors of future ASCVD events than conventional risk factors alone. A recent study has shown that the number of bifurcations with plaque, total plaque thickness (sum of thickness of larger plaque in each bifurcation), and total plaque area (sum of areas of all plaques present in four bifurcations) have a similar net reclassification improvement of 16.1%–16.7%. In addition to this, previous studies demonstrated that common femoral bifurcation plaques are the stronger predictors of risk than carotid plaques. Thus, as far as screening is concerned, it appears that the number of bifurcations with plaque would be sufficient. However, for clinical monitoring of the effect of therapy on plaque progression or regression, measurements of plaque area or volume are the most appropriate. The commercial availability of three-dimensional-probes for superficial vessels will now make measurements of plaque volume relatively easy and the ability to monitor plaque volume changes in a clinical setting possible.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"38 1","pages":"25 - 29"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87238108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/2589-9686.379845
K. Rajapaksha
Offering guideline-based treatment in the era of endovenous thermal ablation of varicose veins (VVs) and image-guided sclerotherapy is a challenge in developing countries due to the financial constraints and lack of expertise. Training in ultrasonography, hand-eye coordination, and technique of endothermal ablation are required in addition to cost reduction measures to offer endovenous thermal ablation of VV in publicly funded hospitals in developing countries. The present article describes step-by-step approach of a general surgeon to acquire skills in duplex ultrasonography, hand-eye coordination, and technique of endovenous thermal ablation therapy to treat patients with VV based on guidelines and to establish institutional VV program in Sri Lanka.
{"title":"Step-by-step approach to setup a guideline-based varicose vein program in a publicly funded hospital in a developing country: A personal experience","authors":"K. Rajapaksha","doi":"10.4103/2589-9686.379845","DOIUrl":"https://doi.org/10.4103/2589-9686.379845","url":null,"abstract":"Offering guideline-based treatment in the era of endovenous thermal ablation of varicose veins (VVs) and image-guided sclerotherapy is a challenge in developing countries due to the financial constraints and lack of expertise. Training in ultrasonography, hand-eye coordination, and technique of endothermal ablation are required in addition to cost reduction measures to offer endovenous thermal ablation of VV in publicly funded hospitals in developing countries. The present article describes step-by-step approach of a general surgeon to acquire skills in duplex ultrasonography, hand-eye coordination, and technique of endovenous thermal ablation therapy to treat patients with VV based on guidelines and to establish institutional VV program in Sri Lanka.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"70 1","pages":"52 - 54"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80290837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endovascular treatment is a universal and effective treatment for superficial femoral artery (SFA) stenosis. However, the high incidence of in-stent restenosis (ISR) after stent implantation is a major limitation for the long-term efficacy of stent therapy. In this article, we selectively queried the PubMed database for literature that reported experimental or clinical studies describing ISR of the SFA. Papers were used to determine risk factors for ISR, including demographics, vascular risk factors, vascular comorbidities, lesion-/procedure-related characteristics, and pathophysiological factors, hemodynamics, and lifestyle-related factors. We found that factors such as advanced age, male sex, hypertension, hyperlipidemia, diabetes mellitus, smoking, longer lesion length, and calcium load plaque are associated with ISR. The drug-coated stent and an oversized ratio of 1.2–1.4 provide the best biomechanical properties after implantation. The data on risk factors for ISR collected in this article may be useful for further research in this field, as well as for recommendations of clinical practice.
{"title":"The study on the risk factors of restenosis after superficial femoral artery stenting","authors":"Xixiang Gao, Chang Yu, Tongyue Li, Xinyu Zhao, Ran Liu, Mingjie Gao","doi":"10.4103/2589-9686.379844","DOIUrl":"https://doi.org/10.4103/2589-9686.379844","url":null,"abstract":"Endovascular treatment is a universal and effective treatment for superficial femoral artery (SFA) stenosis. However, the high incidence of in-stent restenosis (ISR) after stent implantation is a major limitation for the long-term efficacy of stent therapy. In this article, we selectively queried the PubMed database for literature that reported experimental or clinical studies describing ISR of the SFA. Papers were used to determine risk factors for ISR, including demographics, vascular risk factors, vascular comorbidities, lesion-/procedure-related characteristics, and pathophysiological factors, hemodynamics, and lifestyle-related factors. We found that factors such as advanced age, male sex, hypertension, hyperlipidemia, diabetes mellitus, smoking, longer lesion length, and calcium load plaque are associated with ISR. The drug-coated stent and an oversized ratio of 1.2–1.4 provide the best biomechanical properties after implantation. The data on risk factors for ISR collected in this article may be useful for further research in this field, as well as for recommendations of clinical practice.","PeriodicalId":34849,"journal":{"name":"Vascular Investigation and Therapy","volume":"124 1","pages":"30 - 37"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80719390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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