Objective The 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. Methods This 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. Results Seventy-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. Conclusion In 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.
