ObjectiveThe aim of the study was to compare the incidence of IH after abdominal aortic aneurysm (AAA) open repair according to the abdominal wall closure technique used.MethodsThis is a longitudinal, monocentric, and observational study including patients who underwent AAA open repair by midline laparotomy from January 2019 to December 2021 at our institution. Patients were divided in two groups, fascial closure with small bites and prophylactic mesh reinforcement (Group A); and primary fascial closure with small bites alone (Group B). Primary endpoints were the presence of IH during follow-up in both groups and a comparison represented in a Kaplan-Meier curve. Secondary endpoints were to describe the differences between both groups in surgical wound complications, surgical, hospitalization times, and need for reintervention due to IH.ResultsSeventy-five patients underwent AAA open repair and 50 were included after exclusions, 23 in group A and 27 in the group B. Patients were followed-up by, at least, one clinical appointment with image test during first 24 month post-surgery. Six (26%) patients in group A and nine (33%) in group B developed IH during the 24-month follow-up (p = .29). Surgical wound complications were not statistically different, where group A had seven patients (30.4%) and four (14.8%) in group B (p = .30). No statistically significant differences were found in the surgical time (p = .59) in both groups.ConclusionIn this limited cohort, no statistically significant difference was observed in the occurrence of IH with the use of small-bites primary closure plus mesh versus primary closure with small bites alone at 2-year follow-up. Further studies with larger numbers and adequate design are needed to support the use of mesh for IH prevention as stated in current guidelines.
ObjectivesPelvic congestion syndrome (PCS), often underdiagnosed, is a cause of chronic pelvic pain in women and is frequently associated with pelvic varicose veins. Endovascular embolization is an established treatment, traditionally performed via femoral or jugular access. However, these approaches may carry higher risks of complications. This study aimed to evaluate the safety, feasibility, and clinical outcomes of using basilic vein percutaneous access for pelvic vein embolization in patients with PCS.MethodsA retrospective cohort study was conducted on 292 women of reproductive age with symptomatic PCS who underwent pelvic varicose vein embolization using percutaneous access via the distal third of the right basilic vein. The study spanned from 2018 to 2023 and was carried out at two hospitals in Bogotá, Colombia. Inclusion criteria comprised chronic pelvic postcoital pain and Doppler-confirmed pelvic varicosities with reflux diameters >6 mm. Data collected included demographics, CEAP and Symptoms-Varices-Pathophysiology classifications, intraoperative details (access approach, duration, coil usage, complications), and postoperative outcomes (symptom resolution, complications, reintervention, ICU/hospital stay, and mortality). Follow-up evaluations were conducted at 15 days, 3 months, and 6 months post-procedure. Descriptive statistics were used for analysis. A detailed description of the surgical technique used for basilic vein access and embolization was included.ResultsAll 292 procedures were successfully performed using basilic vein access with no access-related complications such as bleeding, thrombosis, or hematoma. The average surgical duration was 41.1 min (SD = 4.1), and a mean of 2.6 coils (SD = 0.7) was used per case. The left gonadal vein was embolized in all patients, with additional embolization of the right gonadal (68.8%) and hypogastric veins (6.8%) when indicated. Only one patient (0.3%) experienced a coil migration resulting in pulmonary embolism, requiring reintervention and a short ICU stay. No mortalities were reported. Symptom resolution was achieved in 278 patients (95.2%), indicating high procedural effectiveness.ConclusionsBasilic vein access is a feasible and safe alternative for pelvic vein embolization in patients with PCS. This approach demonstrated excellent technical success, a low complication rate, and high symptom resolution, with the added benefits of shorter procedure time and reduced coil usage compared to traditional access routes. These findings suggest potential procedural and resource efficiency advantages. However, due to the study's retrospective nature and lack of comparative controls, prospective studies are necessary to further assess the long-term efficacy and cost-effectiveness of basilic access in comparison to femoral and jugular approaches. Establishing standardized guidelines for vascular access in PCS treatment could enhance outcomes and procedural safety.
ObjectivesTo evaluate efficacy and safety of percutaneous-endovascular aneurysm repair (p-EVAR) where large-bore access puncture holes were closed with a suture mediated closure device (SMCD) in all eligible patients.MethodsA single-center cohort of prospectively collected data in an Internal Quality Control Registry (IQCR). An "All Comers" cohort of 368 patients with 736 access groins was assessed. All abdominal aortic aneurysm (AAA) patients eligible for p-EVAR after CTA evaluation were included. Patients with stenosis and occlusions requiring vascular Interventions during EVAR were excluded. The groins were stratified into two groups: low-profile (12Fr - 16Fr) and high-profile introducers (18Fr - 20Fr). PerClose ProGlide (Abbott Cardiovascular, IL, USA) and later the newer version PerClose ProStyle (Abbott Cardiovascular, IL, USA) SMCD devices were assessed. Primary endpoints were: Primary ProGlide technical success and Primary assisted percutaneous and non-invasive technical success. Secondary cutdown was an exclusions criterion. Safety endpoints were Freedom from early peri-operative and late 30-day groin access complications requiring vascular surgical intervention.ResultsPrimary technical success was achieved in 66.4 % (473/712) groins. Primary assisted percutaneous and non-invasive technical success was achieved in 32.2 % (229/712) groins. Continuous hemorrhage in 1.4 % (10/712) groins required a cutdown. 98.6 % (712/736) of the groins were successfully closed percutaneously. Median age was 76 years (IQR 71, 80). 78.8 % were male. 92 % (330/368) of the p-EVAR were elective. Median AAA diameter was 57mm (IQR 53, 63). Few groins required surgical intervention. No statically significant differences were found between the PerClose ProGlide and the ProStyle (p < .05).ConclusionsPercutaneous closure is efficient and safe. Low-profile introducers and EVAR components (12Fr - 16Fr) had slightly better primary technical and assisted technical success. 83.5 % of the patient groins were treated with low-profile introducers reflecting the drive in the vascular field toward lower-profile devices. No statistical difference between groups was observed for primary technical success and complication rate.
BackgroundAccurately predicting treatment responses in varicose vein sclerotherapy is crucial for improving patient quality of life and optimizing overall healthcare costs.PurposeOur study aims to accurately predict treatment responses in telangiectasia and reticular vein treatment in lower extremity sclerotherapy, by taking advantage of machine learning's (ML) ability to navigate complex data sets and provide personalized predictions.Materials and MethodsML algorithms were used to predict outcomes in 99 patients with varicose veins. The data set, which included patient characteristics such as age, gender, dosage, and photographs, was analyzed using six ML methods. Response to treatment was divided into three groups as "poor," "moderate," and "good" as a result of clinical visual evaluation.ResultsIndividuals with no prior treatment exhibited a notably higher rate of "Good" responses than those who had received prior treatment. (p < .001) The group receiving a 2% polidocanol dosage showed a higher rate of "Good" responses than the group receiving a 1% polidocanol dosage. (p = .008) XGBoost outperformed other ML algorithms, particularly excelling in predicting "Poor" responses.DiscussionML-based predictive models for assessing sclerotherapy outcomes in varicose veins, uncovering significant efficacy determinants such as dosage and prior treatment history. While pioneering ML in sclerotherapy prediction, our study acknowledges limitations and proposes future research directions, including additional variable incorporation and real-time predictive tool development.
Objectives Primary ruptured abdominal aortic aneurysm (rAAA) survival has been described in a few case reports; however, to our knowledge, there is no existing literature regarding rAAA survival secondary to isolated type II endoleak (T2EL). We aim to report a rare case of non-operative management for a T2EL-associated rAAA.Methods An 89-year-old man with a history of endovascular aneurysm repair (EVAR) and persistent T2EL presented with acute abdominal pain and hypotension. Computed topography angiography (CTA) confirmed rAAA with retroperitoneal haematoma. Given his advanced age, comorbidities, and initial preference against surgery, non-operative management was chosen.Results After resuscitation, the patient remained stable and was discharged 5 days later. A 4-week follow-up CTA showed haematoma resolution, despite mild enlargement of the aneurysm sac. He underwent elective embolization 2- and 4-month post-rupture. One year later, he represented with acute limb ischaemia. At the time, the treated aneurysm remained stable without endoleak.Conclusion This case study sheds light on the possible different natural history between post-EVAR rAAA and primary rAAA, highlighting the possibility of non-operative management in select hemodynamically stable patients with rAAA after EVAR. While rare, rupture can occur from T2EL, underscoring the need for close surveillance among at risk population.
ObjectiveIliac limb branch occlusion after endovascular aneurysm repair (EVAR) creates risk for limb or pelvic ischemia. This study aims to explore the hemodynamic factors associated with eventual iliac branch occlusion after EVAR for abdominal aortic aneurysm.MethodsSix patients with different causes of iliac branch occlusion were selected between January 2013 and December 2023, and computed tomography angiography (CTA) images were acquired at the time of preoperative and postoperative occlusion of EVAR. Specific CTA images were applied for modeling and computational fluid dynamics (CFD) analysis was implemented.ResultsPressure, velocity, wall shear stress (WSS), time-averaged wall shear stress (TAWSS), oscillatory Shear Index (OSI), and relative residence time (RRT) were calculated. Velocity, WSS, and TAWSS were elevated at the stenosis, and pressure, OSI, and RRT were decreased at the stenosis. Streamlines were reduced at stenotic sites. Iliac branch locations that eventually occluded had more disturbed flow compared to non-occluded sites. Both pressure and flow velocity gradient variations are greater on the occluded side than on the non-occluded side.ConclusionsComputational fluid hemodynamic analysis identified consistent flow disturbances associated with eventual iliac limb occlusion following EVAR. These findings suggest that CFD-based hemodynamic assessment may help stratify patients at risk of iliac branch occlusion before clinical manifestation.
Introduction: Most existing management strategies for spinal cord ischaemia (SCI) after thoracic endovascular aortic repair (TEVAR) are invasive in nature, including intravenous vasopressors, cerebrospinal fluid drainage, and segmental artery embolization. Non-invasive pharmacological adjuncts have been described without established effectiveness. Clinical Case: This case report describes the use of midodrine, an alpha 1-adrenoreceptor agonist, as a rescue therapy adjunctive to phenylephrine to successfully reverse post-TEVAR delayed paraplegia in a 73-year-old patient with ruptured thoracic aortic aneurysm. The initial episode of paraplegia was completely reversed with lumbar drainage, while the second episode was effectively corrected with phenylephrine and subsequently midodrine alone. He had complete neurological recovery, and could mobilize independently. Conclusion: Midodrine is a safe and non-invasive treatment to increase spinal cord perfusion pressure, which could improve or even reverse symptoms of spinal cord ischemia in patients post-TEVAR.
ObjectivesCarotid arterial disease is one of the most important causes of stroke and the gold standard in its treatment is surgical endarterectomy. Different approaches have been reported regarding revascularization methods (stent/surgery) and surgical methods (with shunting/with-out shunting) in patients with contralateral carotid stenosis. In this study, revascularization methods and postoperative follow-up of patients with contralateral carotid arterial stenosis in our clinic were investigated.MethodsPatients who underwent carotid endarterectomy in our clinic between 01.04.2019 and 30.04.2024 were retrospectively analyzed. Patients were divided into 4 groups according to contralateral carotid artery stenosis. On the contralateral side; patients with <50% stenosis constituted Group 1, patients with 50-69% stenosis constituted Group 2, patients with 70-99% stenosis constituted Group 3, and patients with total occlusion constituted Group 4. In all patients, the operation was performed with NIRS monitoring. The groups were compared in terms of postoperative neurological events and mortality.ResultsThere were 248 patients, who had undergone carotid endarterectomy during the study period. There were 143 patients in Group 1, 47 patients in Group 2, 44 patients in Group 3, and 14 patients in Group 4. Demographics, preoperative findings and cross clamping times were similar between the groups. All of the operations except 2 with regional anesthesia were performed under general anesthesia. Shunting was required in 6 patients and arteriotomy was closed with patchplasty in 17 patients. In the comparison of postoperative events, there was no statistically significant difference between the groups in the terms of early-term minor (1.4%, 2.1%, 2.3%, and 0, respectively) and major (0.007%, 0, 2.3%, and 0, respectively) neurological events. There were 5 reoperations due to bleeding (3 in Group 1 and 2 in Group 2) 3 mortalities (1 in Group 1 and 2 in Group 3). There was no neurological event and mortality and 1 restenosis in Group 1 in the follow-up period.ConclusionIn carotid artery stenosis, contralateral carotid artery stenosis is not a marker for determining the revascularization method. Performing the operation with standard precautions without deviating from routine practice has similar results to the surgical approach applied in unilateral stenosis. In these patients, the operation might be performed safely with precautions such as cerebral monitoring and not lowering blood pressure during the operation.
Background/ObjectivesPrevious studies have reported that inflammatory biomarkers have prognostic value in various fields, including vascular surgery. Biomarkers such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) help identify patients at higher risk for cerebrovascular events, as well as in the treatment and follow-up of patients. There are studies investigating the usefulness of these biomarkers for carotid artery disease. However, data on whether they help predict neurological complications after carotid artery surgery are limited. This study examined the correlation between preoperative carotid arterial stenosis severity, symptomatic presentation, and PLR and NLR levels as potential biomarkers for predicting postoperative neurological complications.MethodsWe retrospectively analyzed the preoperative and postoperative demographics, physical examination, and laboratory results of patients who underwent carotid endarterectomy for carotid artery stenosis in our clinic between January 2019 and January 2023.ResultsWhile our findings did not demonstrate a statistically significant correlation between NLR and PLR levels and postoperative neurological complications, elevated platelet counts were associated with such complications, underscoring the importance of antiplatelet therapy in managing carotid artery disease.ConclusionsThe study linked high platelet counts to postoperative complications and highlights the importance of antiplatelet therapy in managing carotid artery disease. The differences in findings highlight the complexity of stroke prediction and the need for a multifactorial approach.
BackgroundIt has been shown that fluoroquinolones (FQs) use may be associated with an increased risk of aortic aneurysm (AA) and/or aortic dissection (AD).ObjectivesThe aim of this meta-analysis was to systematically review and summarize the epidemiological evidence on the risk of aortic AA and/or AD following FQs use.DesignSystematic review and meta-analysis.Data Sources and MethodsWe performed a meta-analysis using data from PubMed, Embase, and the Cochrane Library, with research conducted up to March 15, 2025. Cohort studies examining the association between FQs use and AA or AD were included. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A combined HR with 95% CI was calculated using either a random-effects or fixed-effects model, and robustness was assessed using sensitivity analysis. This meta-analysis was registered with PROSPERO (CRD 420251012072).Results11 studies were included, with 81,976,958 participants. The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06-1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24-1.73) and AD (HR = 1.12, 95% CI: 1.04-1.22). In subgroup analysis, the gender subgroup analysis revealed a higher risk of AA/AD for males (HR = 1.16, 95% CI: 1.06-1.27) compared to females (HR = 1.09, 95% CI: 1.00-1.20). Regionally, the risk was higher in America (HR = 1.47, 95% CI: 1.12-1.93) than Europe (HR = 1.08, 95% CI: 0.98-1.19) and Asia (HR = 0.80, 95% CI: 0.61-1.05). Risk associated with FQs use within 90 days (HR = 1.20, 95% CI: 1.13-1.26) was significantly higher, while no significant increase was observed for ≥365 days (HR = 1.00, 95% CI: 0.90-1.12). The presence of hypertension (HR = 1.24, 95% CI: 1.14-1.36) was associated with a significantly higher risk of AA/AD.ConclusionThis meta-analysis demonstrates that the use of FQs is associated with a significant risk of AA/AD. Clinicians should be aware of this risk in patients prescribed FQs, and further research is needed to elucidate the role of FQs in the development of AA/AD.
BackgroundMajor lower limb amputations, often performed as lifesaving procedures in patients with advanced peripheral vascular disease (PVD), are associated with high rates of postoperative complications and reoperations. Identification of risk factors associated with reoperation is crucial for targeted perioperative management. The objective of the study is to identify the factors associated with increased risk of reoperation following major amputation and to develop and evaluate a predictive model for the same.MethodsA prospective observational study was conducted at our tertiary care centre between October 2022 and December 2023. After taking institutional ethical committee clearance, 83 patients undergoing major lower limb amputations (above or below the knee) for PVD were included in study. Demographic, clinical, and radiological variables were collected and analyzed. Reoperation was defined as any additional procedure requiring revision of the stump within 30 days, excluding minor wound interventions. Multivariable binomial logistic regression analysis was performed to identify independent risk factors associated with reoperation.ResultsThe reoperation rate following major amputation was 44.57%, the two common causes were stump necrosis (40.54%) and wound infections (29.72%). On multivariable analysis, age >60 years (OR: 8.26, p = .001) and arterial blockage above the common femoral artery (CFA) (OR: 4.32, p = .038) emerged as significant independent risk factors. The regression model demonstrated moderate predictive strength with a Nagelkerke R2 value of 40.9% and good model fit (p = .724).ConclusionAdvanced age and proximal arterial occlusion are significant predictors of reoperation after major amputation. The proposed model offers a practical tool for risk stratification, patient counselling, and surgical planning. Multicentre validation is needed to refine its predictive accuracy.
ObjectivesThis study aimed to assess whether Large Language Models (LLMs), like ChatGPT-4, could simplify discharge summaries for vascular surgery patients while maintaining accuracy and completeness, ultimately improving patient comprehension and engagement in their postoperative care.MethodsIn this cross-sectional multicentric study, discharge summaries from 90 vascular surgery patients across three centers were collected. These were divided into three groups based on patient pathology: aortic pathology, peripheral artery disease, and carotid artery disease. Summaries were processed by LLMs to create patient-friendly versions with a target reading level suitable for a 6th-grade education. The readability of the original and AI-generated summaries was evaluated using the Flesch-Kincaid Grade Level and Ease Score. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Print (PEMAT-P), which evaluates the clarity, organization, and actionable nature of the text. Accuracy and completeness were rated using a 6-point Likert scale and a 3-point Likert scale, respectively. Statistical analyses, including paired-samples t-tests, ANOVA, and post-hoc tests, were performed to assess the differences between the original and AI-modified summaries.ResultsAI-generated summaries demonstrated significant improvements in readability, with a 39.6% reduction in Flesch-Kincaid Grade Level and a 106.37% increase in Ease Score. The mean understandability score based on PEMAT-P was 77.71, while the actionability score was 52.12. Accuracy was rated highly (mean score of 5.21), and completeness had a mean score of 2.61. However, 10.8% of summaries had omissions, and 7.5% had hallucinations, with corrections made in some cases.ConclusionsLLMs like ChatGPT-4 can significantly improve the readability and accessibility of discharge summaries for vascular surgery patients, enhancing their understanding and engagement in postoperative care. While the summaries were accurate and complete, the occurrence of errors suggests the need for further refinement to minimize omissions and hallucinations. These findings indicate that AI can be a valuable tool in improving communication between healthcare providers and patients. Future research should focus on reducing errors and enhancing actionability.
BackgroundAbdominal aortic aneurysms (AAAs) are a significant vascular disease characterized by the degradation of medial elastic lamellae, neovascularization, and inflammatory responses. While surgical intervention remains the standard treatment for large or rapidly expanding AAAs, there is no universally accepted pharmacological therapy to prevent aneurysm progression. Matrix metalloproteinases (MMPs), particularly MMP-9, and inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) are implicated in AAA pathogenesis, making them potential therapeutic targets. Doxycycline, a broad-spectrum tetracycline antibiotic, has demonstrated inhibitory effects on MMP-9 and anti-inflammatory properties. However, its efficacy in slowing AAA progression remains unclear.MethodsA systematic review was conducted following PRISMA guidelines. Electronic searches were performed in PubMed, MEDLINE, EMBASE, and ClinicalTrials.gov. Inclusion criteria encompassed randomized controlled trials (RCTs), cohort studies, in vitro studies, and systematic reviews evaluating the effects of doxycycline on AAA growth. Data extraction was performed using Covidence software, and study quality was assessed using the Cochrane Risk of Bias Tool 2.0 (RoB2) for RCTs, the QUIN tool for in vitro studies, and the SYRCLE tool for animal experiments. Statistical analysis employed a random-effects model to evaluate heterogeneity among studies.ResultsThe initial search identified 1313 references, of which 10 studies met inclusion criteria: two RCTs, two systematic reviews, three in vitro studies, one in vivo study, one methodological study, and one experimental study. The two RCTs, involving 515 patients with an average age of 71 years, reported minimal to no significant reductions in AAA growth following doxycycline administration. In contrast, in vitro and in vivo studies demonstrated inhibition of MMP-9 and inflammatory markers, supporting doxycycline's potential therapeutic role. Meta-analysis was not performed due to high heterogeneity (I2 = 75%). Risk of bias assessment indicated a low risk for RCTs, whereas in vitro and in vivo studies showed a moderate risk of bias.ConclusionWhile doxycycline exhibits promising biochemical effects in AAA pathophysiology, its clinical efficacy remains uncertain. Current evidence does not support its routine use in AAA management outside clinical trials. Future research should focus on targeted pharmacotherapy integrating patient-specific biomarkers to enhance therapeutic outcomes.
ObjectiveAlthough some publications are comparing the early clinical and anatomical results of endovenous laser ablation and endovenous cyanoacrylate embolization in great saphenous vein insufficiency, according to our knowledge, there are limited publications comparing the long-term clinical and anatomical results of these methods. I aimed to compare the long-term clinical and anatomical outcomes of these endovenous treatment methods.MethodsA total of 248 patients over the age of 18 who underwent endovenous laser ablation or endovenous cyanoacrylate embolization for the treatment of great saphenous vein insufficiency were included in the study. Patients who have been treated with a treatment method other than these methods were not included in this study. The equal numbers of patients were included in two groups according to the applied treatment methods. The groups were not fully matched in terms of baseline characteristics in this study, and significant differences were detected in age and preoperative reflux duration values (p < .05), and therefore, the results were re-analyzed with models (ANCOVA) adjusted for age and clinical severity parameters.ResultsEndovenous laser ablation or endovenous cyanoacrylate embolization procedures were performed in a total of 248 patients with a mean age of 51.22 ± 13.20 years. There was a statistically significant difference in mean age between the groups (p = .017). The mean preoperative CEAP score of study patients was 3.07 ± 0.57 (between 2 and 6), and the mean preoperative VCSS value was 6.85 ± 1.18. The average follow-up period of the study patients was 3.5 ± 0.50 years and at the end of the follow-up, a decrease in CEAP stage and VCSS values was observed in both groups.ConclusionsThe endovenous cyanoacrylate embolization offers similar long-term success rates to endovenous laser ablation, is a shorter procedure time, and offers advantages in returning to daily activities after the procedure. Both treatment methods, with effective and accessible healthcare systems, offer a variety of treatment options. The results of this study suggest that while both methods reduce the CEAP stage in the long term, endovenous cyanoacrylate embolization may provide a greater reduction. However, endovenous laser ablation may be more effective in reducing symptom severity (VCSS) and may offer an effective treatment option with lower complication rates and similar outpatient benefits and cost-effectiveness.
BackgroundAortic diseases, including aneurysms and dissections, represent a significant global health burden, necessitating advancements in surgical and endovascular interventions. This bibliometric analysis examines the evolution of research trends, key contributors, and emerging themes in the treatment of aortic diseases over the past three decades.MethodsBibliometric data from Scopus and Web of Science databases were analyzed for peer-reviewed articles published between 1994 and 2024. A systematic approach adhering to the PRISMA 2020 framework identified 2985 articles. Descriptive and advanced bibliometric techniques, including citation, co-authorship, and keyword co-occurrence analyses, were employed using tools such as VOSviewer and Biblioshiny.ResultsThe annual scientific output demonstrated consistent growth, with significant contributions from the United States, United Kingdom, and Germany. Leading institutions, including Harvard Medical School and Beth Israel Deaconess Medical Center, played pivotal roles in advancing research. Keywords revealed a dual focus on minimally invasive techniques, such as EVAR and TEVAR, and patient-centered outcomes like quality of life and survival. Collaboration networks and citation analyses highlighted influential authors and foundational studies shaping the field.ConclusionsThe study underscores the importance of global collaboration and technological innovation in advancing aortic disease treatment. While disparities in research representation persist, emerging trends in hybrid approaches, multidisciplinary methods, and outcome-based studies offer promising directions for future research. These findings provide a comprehensive resource for clinicians, researchers, and policymakers seeking to address challenges and improve patient care in this critical field.
ObjectiveTo compare endovascular kissing stent (KS) and aortobifemoral bypass (AFB) procedures in patients with bilateral common iliac artery occlusion.Materials and MethodsThis was a single-centre retrospective study. Subjects who underwent treatment for bilateral TASC II C and D common iliac artery occlusion between August 2013 and August 2021 with at least 3 years of follow-up were included in the study. The study group was divided into kissing stent (group A) and aortobifemoral bypass (group B) groups. The subjects' demographic data (including age, sex, body mass index (BMI), smoking history, comorbid diseases and medications), TransAtlantic Inter-Society Consensus (TASC) II classifications and Rutherford classifications were noted. Preoperative diagnostic data included ankle-brachial index (ABI) measurements and computed tomography (CT) angiography assessments of the aorta and iliac-femoral axis. Intraoperative data (including operative times and complications) and hospital stay data were recorded. Patients were evaluated at the 1st, 3rd, 6th, 12th, 24th and 36th months after the procedure at outpatient visits. The primary patency, primary-assisted patency and secondary patency rates were calculated.ResultsThis study included 120 cases. The mean age of the participants in the study group was 66.18 ± 4.63 years (range: 56-78). The BMI of group A was significantly greater than that of group B (23.13 ± 1.36 for group A and 21.51 ± 1.38 for group B, p = 0.001) (Table 1). The rate of TASC D classification in group B was significantly greater than that in group A (p = 0.001; p < 0.01). The operation time of group B was significantly greater than that of group A (mean of 56 min for group A and 210 min for group B, p = 0.001). Moreover, the hospital stay of group B was significantly longer than that of group A (mean of 1 day for group A and 7 days for group B, p = 0.001).For the follow-up CT angiography measurements, a significant difference was observed between the groups at the 24th month of follow-up (p = 0.023; p < 0.05). The rate of full patency in patients in group B was significantly greater than that in group A (p = 0.027; p < 0.05). Additionally, the rate of 0%-50% stenosis in patients in group B was significantly lower than that in patients in group A (p = 0.023; p < 0.05). Other comparisons, such as those for CT angiography measurements, were not significant (p > 0.05 for all comparisons). Eleven (n = 11, 18.3%) out of sixty subjects in group A and seven (11.7%) out of sixty subjects in group B underwent secondary interventions (p = 0.444). The calculated primary patency, primary-assisted patency and secondary patency rates at 36 months were 68.3%, 21.7% and 10% for group A and 83.3%, 11% and 6.7% for group B, respectively.ConclusionThe use of KS and AFB procedures in subjects with bilateral common iliac artery occlusion has comparable long-term patency rates.
ObjectiveImage fusion allows for reduced operative time and radiation exposure during endovascular aortic operations. There are two approaches to register a preoperative CT scan to the patient; two X-ray images (2D) or a cone beam CT (CBCT, 3D). The goal of this study was to compare accuracy of initial image fusion alignment and time for image fusion setup using 2D versus 3D registration.MethodsWe performed an analysis of patients who underwent endovascular aortic aneurysm repair at our institution. Offline, we re-registered the patient's preoperative CT scan to the images stored from the procedure. We used an anterior-posterior image and a lateral image to register for the 2D approach and used a CBCT for the 3D registration. We then used the patient's initial aortogram to assess accuracy between the actual aortogram and the created virtual mask for both 2D and 3D registration. We chose the inferior angle between renal artery and aorta as the fiducial marker. We measured the time to complete two registration processes. We employed the Wilcoxon matched-pairs signed-rank test to compare the two populations.ResultsA total of 27 patients were evaluated; 11 patients underwent EVAR, 3 FEVAR, 13 PMEG. The median (Q1,Q3) distance between the aortogram and the virtual mask for 3D registration was 8 mm (4,11) and for 2D was 14 mm (9,18.75), (p < .001). 22 patients (81%) had a more accurate registration with 3D image fusion. 2D fusion on average was faster by 93 seconds (p < .001) where time to register was 105 seconds for 2D and 197 seconds for 3D registration.ConclusionsIn the current study, 3D registration showed improved alignment of the fusion image over the 2D registration, at the expense of a longer registration time. This should be further evaluated in larger studies. Despite this added effort, we believe that 3D registration should be considered the preferred initial approach given the importance of an accurate mask for complex procedures.
ObjectivesTo investigate the differences in aneurysmal sac regression after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) in patients with and without dyslipidemia.MethodsThis was a retrospective analysis of 3453 patients from an international prospective registry (Europe, United States of America, Brazil, Australia, and New Zealand) of patients treated with the GORE® EXCLUDER® endograft. All scheduled EVARs for infrarenal AAAs between 2014 and 2016 with complete 6-year follow-up imaging data were included. Logistic regression analysis was performed to assess changes in aneurysm diameter based on dyslipidemia after adjusting for sex, age, body mass index, tobacco use, hypertension, coronary artery disease, aneurysm diameter, aneurysm neck length, and aneurysm neck angle. The secondary outcomes included all-cause mortality, stroke/transient ischemic attack (TIA), paraplegia/paraparesis/spinal cord ischemia, reintervention, endoleaks, and aortic rupture. A control group of patients without dyslipidemia with similar age and comorbidities was selected using propensity scores and matched using a 1:1 scheme.ResultsOf the 3453 patients, 85.3% in the non-dyslipidemia group and 85.5% in the dyslipidemia group were men. The mean age was 73.5 ± 8.8 years for the non-dyslipidemia group and 73.4 ± 8.2 years for the dyslipidemia group (p < .001). The mean body mass index was 26.7 ± 4.9 kg/m2 for the non-dyslipidemia group, whereas it was 28.0 ± 5.2 kg/m2 for the dyslipidemia group (p < .001). Overall, 2269 patients (64.0%) were identified as having dyslipidemia. After propensity score matching (PSM), the dyslipidemia group had higher rates of hypertension (p < .001), TIA (p = .006), carotid disease (p = .002), coronary artery bypass grafting (p = .005), congestive cardiac failure (p = .018), and peripheral artery disease (p < .001). The indications for device placement were similar between the groups. After PSM, the non-dyslipidemia group was more likely to be treated off-label (p = .030) and to have an aneurysm neck length of <15 mm (p = .035). There was no significant difference in the sac size changes within 1 year (p = .7) or 6 years (p = .14) between the groups. After PSM, all-cause mortality was 6.7% in individuals with dyslipidemia and 10.6% in those without (p = .018). However, there were no significant differences in aortic-related mortality between the overall (p = .571) and the matched (p = .662) populations. The rates of reintervention, stroke/transient ischemic attack, and spinal cord ischemia were not significantly different. Among patients with dyslipidemia, larger aneurysm size at 1 year (p = .037) and increased age at 6 years (p < .001) were associated with sac expansion.ConclusionIn this comprehensive real-world study of patients who underwent EVAR with the GORE® EXCLUDER endoprosthesis found that dyslipidemia did not increase endoleak rates or worsen imaging outcomes over 6 years. Overall, these findings suggest that dyslipidemia does not negatively impact EVAR outcomes and may indicate improved long-term care.
IntroductionThe Vascular Quality Initiative (VQI) of the Society for Vascular Surgery (SVS) is a collection of 14 registries that collects data on over 1,000,000 vascular procedures performed in North America. These registries exist in order to improve the quality, safety, and cost of vascular healthcare. Centers participating in the VQI are subject to routine audits to ensure accurate and comprehensive data entry. The aim of the study is to describe a single-institution experience with the VQI audit of the thoracic endovascular aortic repair (TEVAR)/complex endovascular aneurysm repair (EVAR) registry, highlighting the benefits and lessons learned from participating in the audit.MethodsIn 2022, our institution received a VQI audit notification to review all TEVAR/complex EVAR procedures performed between January 1st, 2021 and December 31st, 2021. The institutional financial department obtained claims validation data for all procedures billed under corresponding CPT codes for the listed dates. This was matched against the procedures entered manually into the VQI database by institutional data managers and abstracters. Mismatches between claims validation data and VQI entries were identified and sent to a coding specialist for review and possible revision.ResultsBetween January 1, 2021 and December 31, 2021, there were 125 unique TEVAR/complex EVAR patients identified by either the claims validation data or manually entered VQI registry data. Sixteen patients were listed in the VQI registry only and one patient was identified by claims validation data only, leaving 108 patients that were identified by both the registry and claims data, for an 86% (108/125) match rate. The audit revealed that 13 patients were incorrectly billed, of which 12/13 patients were incorrectly billed as TEVAR extensions (CPT 33886) instead of new TEVAR procedures (CPT 33880). Recoding and rebilling these patients had significant financial implications to the institution.ConclusionThis audit highlighted the importance of meticulous coding and manual review to maintain registry accuracy and optimize financial outcomes. Our findings underscore the necessity of ongoing education for coding and billing personnel and the value of VQI participation in identifying coding discrepancies and improving institutional practices.
