Vascular And Endovascular Surgery[JOURNAL]
Sun
200 papers
Drug Eluting Stents as a Management for Patients with Below the Knee Peripheral Artery Disease: A Systematic Review and Meta-Analysis.
Krishnan P, Tarricone A, Gee A … +4 more , Lee DW, Mehta J, Lavery LA, Sharma S
Vasc Endovascular Surg · 2025 Jul · PMID 40621783 · Publisher ↗
PurposeThe purpose of this study was to compare the effectiveness and safety of drug eluting stents with percutaneous transluminal angioplasty and bare-metal stents in below the knee peripheral artery disease. : The syst...
PurposeThe purpose of this study was to compare the effectiveness and safety of drug eluting stents with percutaneous transluminal angioplasty and bare-metal stents in below the knee peripheral artery disease. : The systematic review was registered in Research Registry. A literature search was performed across four databases: PubMed, Medline/Embase, Cochrane Review, and Web of Science for eligible comparative studies. The primary outcomes examined were mortality, major amputation (above the ankle), minor amputation (below the ankle), and clinically driven target lesion revascularization (CD-TLR). A random effects model was used when pooling outcomes to account for heterogeneity.Main FindingsA total of 7 studies were included in this systematic review and meta-analysis. All subjects were treated for below the knee lesions and CLTI was confirmed as Rutherford ≥4 in 669/955 (70.0%). Among the studies, 572 were treated with a drug eluting stents and 477 treated with non-DES modalities. Pooled analysis showed that DES significantly reduced minor amputations and CD-TLR, O.R = 0.56 [0.32, 0.96], and O.R = 0.38 [0.25, 0.60], respectively. In subgroup analysis, paclitaxel eluting stents were not associated with either survival or major amputation. Everolimus/sirolimus eluting stent use was associated with reduced CD-TLR, O.R = 0.36 [0.21, 0.61].ConclusionThis study suggests that Drug-Eluting Stents (DES), irrespective of type, provide protection against minor amputations and CD-TLR. However, they do not seem to have a significant impact on overall survival rates or the risk of major amputations.
Systematic Review and Meta-Analysis of the Effect of Chronic Kidney Disease on Amputation and Mortality in Patients With Peripheral Artery Disease.
Zhang Y, Liao Y, Guo H
Vasc Endovascular Surg · 2025 Oct · PMID 40614060 · Publisher ↗
BackgroundThe influence of presence/absence chronic kidney disease (CKD) on the clinical course and outcomes of patients with peripheral artery disease (PAD) has not been extensively investigated. We aimed to measure the...
BackgroundThe influence of presence/absence chronic kidney disease (CKD) on the clinical course and outcomes of patients with peripheral artery disease (PAD) has not been extensively investigated. We aimed to measure the relative rates of amputation and mortality in individuals with different stages of CKD compared to those without CKD, and to assess whether revascularization treatments might reduce these risks for PAD patients.MethodsWe conducted a thorough search of the literature across multiple databases, including MEDLINE, EMBASE, the Cochrane Library, and Web of Science. The risk of bias assessment was assessed using the Newcastle-Ottawa Quality Assessment scale. All studies that reported relevant results in PAD patients were included. The statistical analysis involved the calculation of pooled prevalence estimates using a random-effects model, along with the performance of subgroup analyses and meta-regression to evaluate heterogeneity.ResultsWe included fourteen observational studies encompassing a total of 554,270 patients with PAD that met the predefined inclusion criteria. Eleven studies reported on amputation rates in patients with and without CKD. Our analysis showed that CKD patients faced nearly double the risk of amputation compared to those without CKD (1.94; 1.90 to 1.97; < 0.001; I = 96.8%, < 0.001). Additionally, a significant rise in mortality risk among CKD patients was observed across 14 studies, in comparison to patients without CKD (OR 2.04; 95% CI 1.99 to 2.08; < 0.001; I = 78.6%, < 0.001). Moreover, we observed a graded increase in both amputation and mortality rates with the progression of CKD severity. In terms of therapeutic interventions, the potential of revascularization procedures to lower mortality and amputation rates appeared to be attenuated in the presence of CKD in PAD patients. Meta-regression analysis revealed that only a baseline diabetic population exceeding 50% exhibited a borderline association with amputation rate (β 0.422; 95% CI [-0.189; 1.035]) after adjusting for other covariates, including sample size, percentage of patients with critical limb ischemia, and follow-up time.ConclusionThe significant association noted between CKD and risk of amputation and mortality with PAD, with this risk intensifying as renal insufficiency progresses. Furthermore, the effectiveness of revascularization procedures in reducing amputation and mortality rates is diminished in patients with PAD who also have CKD.
Saphenous Bypass for Treating Anterior Nutcracker Syndrome After Failed Renal Vein Transposition: A Case Report.
Ali AA, Abdelgawad MM, Soliman MA … +1 more , Mowafy KA
Vasc Endovascular Surg · 2025 Oct · PMID 40601031 · Publisher ↗
AimTo report on a case of renal vein anterior nutcracker syndrome (ANCS) that was treated using saphenous vein bypass after a failed attempt of renal vein transposition.CaseA 42-year-old female presented with gross hemat...
AimTo report on a case of renal vein anterior nutcracker syndrome (ANCS) that was treated using saphenous vein bypass after a failed attempt of renal vein transposition.CaseA 42-year-old female presented with gross hematuria and flank pain. Computed tomography revealed a left renal vein (LRV) anterior nutcracker syndrome. An attempt to perform LRV transposition failed due to short vein length. A saphenous bypass was then harvested to perform a bypass between the inferior vena cava and LRV. At 6-month follow-up, the patient remained symptom-free, and imaging confirmed graft patency.ConclusionSaphenous vein bypass presents a viable option in patients with short renal vein or failed renal vein transposition in cases of ANCS.
Unmasking Renal Artery Pseudoaneurysm: A Rare and Elusive Cause of Hypertension.
Shivakumar D, Khan MF, Yadavali RP … +2 more , Siddini V, Ballal HS
Vasc Endovascular Surg · 2025 Oct · PMID 40575925 · Publisher ↗
A 49-year-old man with hypertension for 2 years, was incidentally found to have right intrarenal aneurysms during a routine abdominal ultrasound examination. He reported fluctuating blood pressure readings over the past...
A 49-year-old man with hypertension for 2 years, was incidentally found to have right intrarenal aneurysms during a routine abdominal ultrasound examination. He reported fluctuating blood pressure readings over the past 18 months. Laboratory parameters were within normal limits, with a serum creatinine level of 1.05 mg/dL. An abdominal CT angiogram revealed a large lobulated intrarenal aneurysm in the lower pole, which communicated with another smaller cortical aneurysm. Additional features suggested the presence of an arteriovenous (AV) fistula. Upon further questioning, the patient disclosed a history of blunt abdominal trauma following a motor vehicle accident 3 years ago. This trauma likely explains the CT findings and the development of hypertension secondary to renovascular disease in this patient. Angiography confirmed the presence of 2 renal artery pseudoaneurysms in the midpolar region, for which selective coil embolization was performed. The patient was stable and asymptomatic at his 2-week follow-up. His blood pressure reading was 110/80 mmHg, showing improvement compared to his pre-procedure recordings. There are very few reported cases of renal pseudoaneurysms causing secondary hypertension. Additionally, this case highlights that successful embolization can result in a substantial improvement in hypertension in these patients.
Endovascular Repair of Dual Visceral Artery Aneurysms With Flow-Diverting Stents: A Case Report.
Canyiğit M, Beşler MS, Tekdemir H
Vasc Endovascular Surg · 2025 Oct · PMID 40575866 · Publisher ↗
BackgroundWith the increasing use of diagnostic imaging methods in daily practice, the incidence of visceral artery aneurysms has also risen. VAAs are observed in intra-abdominal regions such as the celiac artery, superi...
BackgroundWith the increasing use of diagnostic imaging methods in daily practice, the incidence of visceral artery aneurysms has also risen. VAAs are observed in intra-abdominal regions such as the celiac artery, superior mesenteric artery, inferior mesenteric artery, and renal arteries, with treatment indications and methods varying based on location, size, and symptoms.Case ReportThis clinical report describes the successful endovascular management and short-term follow-up of incidentally detected fusiform aneurysms in the celiac artery and superior mesenteric artery of a 67-year-old male patient using flow-diverting stents.ConclusionThis case highlights the safety, effectiveness, and success of endovascular treatment with flow-diverting stents for fusiform aneurysms involving the celiac artery and superior mesenteric artery.
Outcomes in Endovascular Management of May Thurner Syndrome Without Access to IVUS in a Latin American Cohort: A Retrospective Study.
Pinzón-Pinto M, Portilla-Rojas E, Ebratt A … +5 more , Mutis-Toro JM, Arévalo-Montaño D, Contreras M, Randial L, Cabrera-Vargas LF
Vasc Endovascular Surg · 2025 Oct · PMID 40570544 · Publisher ↗
Introduction and ObjectiveMay Thurner Syndrome (MTS) is a condition characterized by left iliofemoral vein compression, often leading to lower limb symptoms and complications. This study aimed to evaluate the outcomes of...
Introduction and ObjectiveMay Thurner Syndrome (MTS) is a condition characterized by left iliofemoral vein compression, often leading to lower limb symptoms and complications. This study aimed to evaluate the outcomes of endovascular management for symptomatic, non-thrombotic MTS in a Latin American population.MethodsA retrospective cohort study analyzed 43 patients with MTS who underwent endovascular stenting and anticoagulation between 2018 and 2023 in Bogotá, Colombia. Clinical data, including demographics, symptoms, and comorbidities, were collected. Perioperative outcomes, such as procedure time, complications, and length of stay, were recorded. Postoperative follow-up included stent patency, symptom resolution, and the occurrence of complications.ResultsEndovascular management demonstrated high efficacy, with 83.7% of patients achieving symptom resolution and 100% stent patency at 6 months. No major complications were reported. The average procedure time was 52.6 minutes, and patients were discharged within 1 day of the procedure.ConclusionEarly intervention with endovascular embolization is crucial for patients with MTS and symptomatic pelvic varices. This approach offers a safe and effective solution for managing the condition and preventing complications. The presence of symptoms should be considered an indication for endovascular intervention, rather than waiting for thrombosis development.
Expanding the Use of the Comaneci Neck-Bridging Device for Endovascular Treatment of Complex Renal Artery Aneurysms.
Clemo D, Giacaman P, Nuñez L … +2 more , Lindner C, Concha A
Vasc Endovascular Surg · 2025 Oct · PMID 40570380 · Publisher ↗
Renal artery aneurysms (RAA) carry significant rupture risks, yet wide-neck variants challenge conventional endovascular techniques. Purpose: We report the successful exclusion of a wide-neck RAA using the Comaneci neck-...
Renal artery aneurysms (RAA) carry significant rupture risks, yet wide-neck variants challenge conventional endovascular techniques. Purpose: We report the successful exclusion of a wide-neck RAA using the Comaneci neck-bridging devide in a patient with renal fibromuscular dysplasia (FMD), highlighting its utility and limitations. Single-case report. A 50-year-old hypertensive female with renal FMD presenting with a 27-mm saccular, wide-neck RAA. Data collection: Following multidiscplinary discussion favoring renal parenchyma preservation, endovascular coiling using the Comaneci device was performed via brachial access. The device stabilized the aneurysm neck during sequential coil (Hydroframe, Cosmos, Complex) placement. Posprocedural and 24-month follow-up imaging assesed occlusion, renal perfusion, and complication. Postprocedural imaging confirmed complete aneurysm occlusion, preserved renal perfusion, and the abscense of complications, which was sustained at the 24-month follow-up. This case demonstrated the Comaneci device's safety and efficacy for excluding anatomically complex RAAs, particularly in FMD-associated vessels where permanent stents risk endothelial injury. Technical challenges include device sizing limitations in larger visceral arteries and the need for dual microcatheter strategies, underscoring operator expertise importance. Critical gaps identified are the lack of standarized protocols for visceral applications and insufficient long-term coil stability data. Findings advocate for device modifications for non-cerebral anatomies and prospective trials compating outcomes with balloon-assisted coiling or flow diversion. While highlighting the Comaneci's niche role in RAA management, cautious adoption is urged pending robust evidence.
Surgical Treatment of Lower Limb Lipodermatosclerosis Secondary to Congenital Absence of Infrarenal Inferior Vena Cava and Bilateral Common Iliac Veins.
Wu P, Li F, Wu M … +1 more , Tang D
Vasc Endovascular Surg · 2025 Oct · PMID 40556341 · Publisher ↗
BackgroundThe management of cutaneous dystrophy of lower limb resulting from congenital absence of inferior vena cava (IVC) primarily includes anticoagulation, compression stocking and bypass surgery. However, the clinic...
BackgroundThe management of cutaneous dystrophy of lower limb resulting from congenital absence of inferior vena cava (IVC) primarily includes anticoagulation, compression stocking and bypass surgery. However, the clinical significance of surgical intervention for great saphenous vein (GSV) and pathologic perforator veins (PPVs) in combination with compression therapy remains unrecognized.Case ReportWe present a case report of a 44-year-old man experiencing bilateral legs heaviness and pain upon prolonged standing, as well as left leg lipodermatosclerosis due to congenital absence of infrarenal IVC and bilateral common iliac veins. He underwent ligation and stripping of GSV along with ligation of PPVs followed by postoperative compression therapy. After 7 years of follow-up, all symptoms and signs completely resolved with a decrease in venous clinical severity score from 16 preoperatively to 3 postoperatively.ConclusionFor patient with lower limb cutaneous dystrophy due to the absence of IVC, it is feasible to perform high ligation and stripping of the GSV on the basis of accurate anatomic and hemodynamic evaluation, but long-term compression therapy is required.
Unveiling Aortic Angiosarcoma: A Rare and Aggressive Vascular Malignancy in Vascular Oncology - A Case Report.
Baškytė AM, Opulskis D, Kuprytė M … +2 more , Jankauskas A, Velička L
Vasc Endovascular Surg · 2025 Oct · PMID 40542819 · Full text
Primary aortic malignancy is a very rare pathology, with only 190 cases of aortic tumors reported in the literature to date. Usually, symptoms are insidious and nonspecific, so the disease is diagnosed at an advanced sta...
Primary aortic malignancy is a very rare pathology, with only 190 cases of aortic tumors reported in the literature to date. Usually, symptoms are insidious and nonspecific, so the disease is diagnosed at an advanced stage. Here, we present a case report of a primary malignant tumor of the aorta. In our case, the diagnosis was established using computed tomography angiography (CTA) and biopsy of indeterminate masses obtained during aortography. The patient underwent surgical resection of the affected aortic segment along with a tumor. Histopathological examination revealed the diagnosis of a primary malignant tumor of the aorta - angiosarcoma. Postoperatively, patient received adjuvant chemotherapy according to the standard treatment regimen for sarcoma. One month later, postoperative CT of a chest, abdomen and pelvis was performed, revealing no evidence of metastases or pathological lymph nodes in the examined areas. : Combined surgical and systemic therapies may improve overall survival.
Bilateral Acute Lower Limb Ischemia Caused by Paradoxical Embolism Through a Patent Foramen Ovale Treated With the DISASTER Technique: A Case Report.
Umehara E, Nagase Y, Yao S … +4 more , Miyajima A, Inoue N, Hagikura A, Kusuyama T
Vasc Endovascular Surg · 2025 Oct · PMID 40539598 · Publisher ↗
BACKGROUND: Paradoxical embolism (PDE) through a patent foramen ovale (PFO) is a rare cause of acute limb ischemia (ALI). When surgical thrombectomy using a Fogarty catheter is not feasible, the DISASTER technique repres...
BACKGROUND: Paradoxical embolism (PDE) through a patent foramen ovale (PFO) is a rare cause of acute limb ischemia (ALI). When surgical thrombectomy using a Fogarty catheter is not feasible, the DISASTER technique represents a viable and effective endovascular treatment strategy. CASE REPORT: A 51-year-old woman presented with the sudden onset of bilateral lower extremity pain and coldness. She had been receiving estrogen therapy for irregular menstruation. Angiography revealed a claw sign in the distal superficial femoral artery. She declined surgical thrombectomy due to concerns about invasiveness. Catheter-directed thrombectomy and thrombus aspiration were performed using the DISASTER (Diamond-Shaped wire Accelerate Splicing process of Thrombus used for Emergent Revascularization) technique. Ultrasound examination identified a thrombus distal to the left common femoral vein. Anticoagulation therapy with a direct oral anticoagulant (DOAC) was initiated. Comprehensive hematological testing revealed no evidence of an underlying coagulopathy. Additionally, no intracardiac thrombus or valvular vegetations were detected. Transesophageal echocardiography (TEE) identified a Grade 2 patent foramen ovale (PFO), suggesting paradoxical embolism as the likely etiology. The patient remained free of thromboembolic events postoperatively. CONCLUSION: This report highlights the feasibility of catheter-directed thrombectomy and thrombus aspiration as an effective alternative to surgical intervention for acute limb ischemia. In cases of ALI of unknown etiology, paradoxical embolism should be suspected. Therefore, a comprehensive evaluation, including venous ultrasound and transesophageal echocardiography, is essential to identify a potential PFO or other embolic sources. Early recognition and appropriate management of paradoxical embolism may help prevent recurrent thromboembolic events and improve patient outcomes.
Innovative Approach for Successful Cure of a Digital AVM With Glue and Venous Tourniquet.
Garg P, Sindhwani G, Saini A … +1 more , Singh R
Vasc Endovascular Surg · 2025 Oct · PMID 40539325 · Publisher ↗
BackgroundArteriovenous malformations (AVM) of the digits are rare and carry a poor prognosis after surgical resection and embolisation and usually end up in digital amputation. We present a unique case of a digit AVM tr...
BackgroundArteriovenous malformations (AVM) of the digits are rare and carry a poor prognosis after surgical resection and embolisation and usually end up in digital amputation. We present a unique case of a digit AVM treated using glue by dual approach, ie, transarterial and percutaneous route with a proximal tourniquet, where we could completely salvage the digit involved with a significant reduction in symptoms.Case PresentationWe report a case of a 20-year-old male who presented with swelling of the right ring finger for the past 10 years, with new onset pain and increased swelling size in the last 2 years. A diagnosis of arteriovenous malformation was made on ultrasound and magnetic resonance angiography (MRA) imaging. To salvage the digit, meticulous planning and multidisciplinary discussion for embolization using super-selective angiography were done. Successful embolisation of nidus with feeder from both metacarpal arteries of the ring finger was done using glue by transarterial and percutaneous route with a proximal tourniquet. Near total obliteration of nidus was achieved with no early opacification of the draining vein. Short-term follow-up of 4 months revealed a significant reduction of swelling and pain with no major complication.ConclusionsGlue embolization with a dual approach and proximal tourniquet is safe and effective in digital AVM for symptom reduction with no major complication.
Successful Management of Spontaneous Iliac Vein Rupture With Coil Embolization: A Case Report.
Aoki Y, Otaguro T, Hayashida T … +2 more , Hayakawa K, Sakamoto I
Vasc Endovascular Surg · 2025 Oct · PMID 40538370 · Publisher ↗
BackgroundSpontaneous iliac vein rupture is a rare but life-threatening condition, often associated with deep vein thrombosis (DVT). Current treatment options include surgical repair and endovascular interventions, but c...
BackgroundSpontaneous iliac vein rupture is a rare but life-threatening condition, often associated with deep vein thrombosis (DVT). Current treatment options include surgical repair and endovascular interventions, but consensus on optimal management is lacking.Case ReportA 74-year-old woman presented with hypotension, altered consciousness, and left leg swelling. Imaging revealed a massive retroperitoneal hematoma with active bleeding from a ruptured left external iliac vein. Successful hemostasis was achieved using coil embolization, followed by anticoagulation for DVT management.ConclusionThis case demonstrates that coil embolization can be an effective minimally invasive treatment option for spontaneous iliac vein rupture, particularly in patients who may not tolerate surgical intervention.
Shattered by Light: Catheter Fractures and the Hidden Danger of Angio-Seal Device Failure in the Femoral Artery.
Kotaki R, Shastri R, Ghasemi-Rad M
Vasc Endovascular Surg · 2025 Aug · PMID 40407784 · Publisher ↗
We report a case of a 77-year-old male with pancreatic cancer and thrombocytopenia who presented with acute stroke symptoms and underwent successful endovascular thrombectomy. During femoral artery closure, an 8-F Angio-...
We report a case of a 77-year-old male with pancreatic cancer and thrombocytopenia who presented with acute stroke symptoms and underwent successful endovascular thrombectomy. During femoral artery closure, an 8-F Angio-Seal device fractured, leaving catheter fragments in the right femoral artery, confirmed on imaging. Device analysis revealed oxidation-induced brittleness, leading to sheath fragmentation. This case highlights a rare complication of Angio-Seal devices, suggesting potential material vulnerabilities that warrant further investigation.
Arterial Palmar Arch Aneurysms Management: Case Series.
Carvalho Lujan RA, Godeiro Fernandez M, Costa Sampaio Silva F … +4 more , Azevedo Lujan G, de Melo Mascarenhas DA, Pereira de Souza Filho ML, Aras Junior R
Vasc Endovascular Surg · 2025 Oct · PMID 40384593 · Publisher ↗
IntroductionTrue aneurysms of the upper limb, particularly in the hands, are rare and challenging to manage. We aim to report two cases of true arterial palmar arch aneurysms surgically treated.Case ReportThe first case...
IntroductionTrue aneurysms of the upper limb, particularly in the hands, are rare and challenging to manage. We aim to report two cases of true arterial palmar arch aneurysms surgically treated.Case ReportThe first case involved a 45-year-old male professional martial artist with an ulnar artery aneurysm extending to the superficial palmar arch in the right hand. The second case was a 32-year-old female administrative assistant with a radial artery aneurysm in the left hand. Despite their respective professions, neither patient had a history of significant trauma, recent excessive training, or prolonged work hours. Clinically, both presented with local pain. Diagnostic imaging confirmed the aneurysms. The surgical interventions included proximal and distal vessel ligation and aneurysm resection under local anesthesia. Both patients were discharged on the first postoperative day without complications and showed no vascular complications during a 5-year follow-up.ConclusionAneurysms with marked rarity require individualized treatment with surgical options tailored to the clinical presentation and vascular status.
Transcarotid Artery Approach for Endovascular Aortic Repair in Treating Complex Descending Thoracic Aortic Pseudoaneurysm With Aortoiliac Occlusion: A Case Report.
Shi H, Guo X, Su C … +6 more , Huang H, Chen Y, Zhang J, Zhang B, Feng X, Shen Z
Vasc Endovascular Surg · 2025 Oct · PMID 40347086 · Publisher ↗
BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Cur...
BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Current diagnostic and treatment guidelines generally advocate for endovascular aortic repair in most cases, with the femoral artery serving as the conventional access route. However, this approach may not be feasible for all patients, particularly those with aortoiliac artery occlusion, necessitating alternative access strategies.Case SummaryThis paper presents a complex case study of a patient with aortoiliac artery occlusion who underwent endovascular aortic repair via the left carotid artery approach for a pseudoaneurysm at the anastomotic site of a descending aortic prosthetic graft. This case underscores the potential value of utilizing the carotid artery as an alternative access route in anatomically challenging situations.ConclusionResearch on transcarotid artery approach endovascular aortic repair is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This case report suggests that endovascular aortic repair via the carotid artery approach may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. While our single case demonstrated successful management with minimal complications, larger studies are needed to fully establish the safety profile and determine if perioperative complications and mortality rates are indeed manageable across diverse patient populations.Clinical ImpactThis study provides valuable insights into the feasibility of the carotid artery as an alternative access route for endovascular aortic repair in patients with aortoiliac artery occlusion. It offers clinicians a potential strategy for cases where the conventional femoral artery route is not feasible. The findings presented herein aim to demonstrate the practicality and relative safety of utilizing the carotid artery for endovascular procedures in anatomically challenging scenarios, contributing to the broader understanding of access alternatives in aortic repair interventions.
Aortoenteric Fistulas Following Endovascular Aortic Aneurysm Repair: A Review.
Rey J, Bornak A, Montoya C … +6 more , Polania C, Kenel-Pierre S, Kang N, Sussman M, Gonzalez K, Erben Y
Vasc Endovascular Surg · 2025 Oct · PMID 40340624 · Publisher ↗
BackgroundSecondary aortoenteric fistulas (SAEF) following endovascular aortic repair (EVAR) is an extremely rare event but life threatening. Our review offers comprehensive knowledge on pathophysiology, clinical present...
BackgroundSecondary aortoenteric fistulas (SAEF) following endovascular aortic repair (EVAR) is an extremely rare event but life threatening. Our review offers comprehensive knowledge on pathophysiology, clinical presentation, diagnosis, and treatment options.AimTo summarize the current literature regarding pathophysiology, clinical, diagnostic and therapeutic approach of aortoenteric fistulas secondary to EVAR.MethodsWe performed a literature search in Pubmed/MEDLINE to identify the literature published about SAEF after EVAR. Cases were summarized in a table and prevalences. Other relevant literature was included in the results sections.ResultsA total of 35 reports (single cases and small series) with 45 patients were included. SAEF after EVAR can result from infection, inflammation, or mechanical factors. Clinical presentation is often non-specific, ranging from a gastrointestinal herald bleed to hemorrhagic shock, or malaise and general infection-related symptoms. Cross-sectional imaging plays a critical role in diagnosing SAEF. The treatment approach involves a multidisciplinary team approach and requires broad-spectrum intravenous antibiotics, endovascular intervention for urgent hemorrhage control, and open surgical intervention for definitive repair. Long-term antimicrobial therapy is essential to avoid reinfection.ConclusionsSAEF following EVAR represents a complex, life-threatening condition with limited evidence-based management strategies. Given the growing prevalence of endovascular procedures, comprehensive knowledge of SAEF is crucial for all health care providers to improve early diagnosis and outcomes.
Surgical Options and Outcomes for Renal Vein Entrapment.
Schweitzer G, Jreij G, Dunlap E … +2 more , Fitzpatrick S, Nagarsheth K
Vasc Endovascular Surg · 2025 Oct · PMID 40320391 · Publisher ↗
BackgroundRenal vein entrapment is compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta. When symptomatic, this condition is referred to as nutcracker syndrome (NCS).MethodsThis r...
BackgroundRenal vein entrapment is compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta. When symptomatic, this condition is referred to as nutcracker syndrome (NCS).MethodsThis retrospective study reviews outcomes of 53 patients who underwent surgical correction of NCS at a tertiary care university medical center. Preoperatively, each patient underwent outpatient workup, including diagnostic venography with intravascular ultrasound (IVUS).ResultsThe patients were 98% female, average age of 33.6 years, and body mass index of 21.5 kg/m. Those who became surgical candidates, had either left flank or left upper quadrant abdominal pain. Preoperative venography and IVUS demonstrated a mean left renal vein (LRV) stenosis of 74%, and dilated LRV collaterals were identified in 64%. Presenting symptoms were provoked with catheter advancement, and with contrast injection into the LRV or its tributaries in 74% and 45% of venograms, respectively. Surgery consisted of renal vein transposition (RVT) in 43 patients, autotransplantation (AT) in 6, and gonadal vein transposition (GVT) in 4. Renal artery denervation was done in 39/47 patients (83%) who had RVT or GVT. LRV reconstruction was needed in 15/43 patients (35%) who had RVT because the vein was too short or scarred for transposition. There were 7 renal vascular complications after RVT (none with AT or GVT), most following bovine pericardial neoconduit. After 11.2 ± 1.2 months of follow up, patients in this study reported that their symptoms had resolved in 43%, improved in 36%, improved then recurred in 13%, and had not changed in 8%. Good outcome was achieved after AT in 100%, after RVT in 79%, and after GVT in 50%.ConclusionsAlgorithm-based surgical management of NCS leads to symptom resolution or improvement in most patients. Renal vein reconstruction with bovine pericardial neoconduit is associated with a high rate of vascular complications.
Endovascular Skirt Reconstruction of Aortoiliac Bifurcation Using Bare-nitinol Stents: ESCORT Technique.
Shimada T, Shimada Y, Tonomura D … +3 more , Terashita K, Yamanaka Y, Fukuda D
Vasc Endovascular Surg · 2025 Oct · PMID 40312966 · Publisher ↗
BackgroundEndovascular treatment for aortoiliac occlusive disease (AIOD) is still challenging. We propose a stent deployment technique for AIOD using only bare-nitinol stents (BNSs) in a form that is ultimately similar t...
BackgroundEndovascular treatment for aortoiliac occlusive disease (AIOD) is still challenging. We propose a stent deployment technique for AIOD using only bare-nitinol stents (BNSs) in a form that is ultimately similar to the normal aortoiliac bifurcation structure.Methods and case seriesThe Endovascular Skirt reCOnstruction of aoRToiliac bifurcation using bare-nitinol stents (ESCORT) technique involves primary implantation of a large BNS, with its distal edge being placed just at the edge of the carina by mounting onto 2 pull-through guidewires from the side of an upper extremity followed by V-stenting using BNSs into the pre-implanted BNS at the terminal aorta. The results of experiments showed that this technique can be achieved by the unique structural characteristic of an E-Luminexx Vascular stent (BD, Tempe, AZ, USA) as a main body in which the stent edge can be advanced beyond the catheter tip. This technique without using stent grafts can avoid recrossing of the jailed guidewire and can reduce the procedural and long-term care that is necessary when using stent grafts, and a future cross-over approach may be established also after treatment. Between 2017 and 2021, the ESCORT technique was performed in 7 consecutive cases of AIOD at our institute. The procedural success rate was 100%, and no complication occurred in any of the patients. Symptom resolution was obtained in all patients. Target lesion revascularization (TLR) was performed in 1 patient with extremely severe calcified lesions. Except for the 1 case requiring TLR, at least 2-year patency was confirmed in patients who were followed up. The establishment of a cross-over system was tried in 2 patients after the procedure, and it was successful in both cases.ConclusionThe ESCORT technique for AIOD is a feasible and beneficial stenting strategy.
Endovascular Treatment of Primary Bilateral Racemose Hemangioma With Multiple Bilateral Bronchial Artery Aneurysms: A Case Report and Review of Literature.
Rouhezamin MR, Haseli S, Golzarian J … +1 more , Rokni H
Vasc Endovascular Surg · 2025 Oct · PMID 40304633 · Publisher ↗
A 36-year-old man was presented with hemoptysis. The contrast enhanced chest computed tomography and bronchial angiography revealed multiple bilateral ostial and intraparenchymal bronchial artery aneurysms (BAA) and bila...
A 36-year-old man was presented with hemoptysis. The contrast enhanced chest computed tomography and bronchial angiography revealed multiple bilateral ostial and intraparenchymal bronchial artery aneurysms (BAA) and bilateral primary Racemose hemangioma (PRH). Endovascular embolization with polyvinyl alcohol and n-butyl-2-cyanoacrylate was preferred to occlude the BAAs. Five days after the procedure, the patient was discharged and remained stable without recurrence over the 6 month follow up. To the best of our knowledge, this is the first case of PRH with multiple bilateral BAAs and the second published case of bilateral BAAs. This study aims to describe the successful treatment method employed for management of this rare condition and review the published articles relating to BBA and PRH.
Early Results of a Single-Center Prospective Clinical Trial: In Situ Fenestration System for Aortic Dissection.
Tan Y, Chen W, Li Z … +9 more , Xu H, Zhao Y, Zhou D, Bai Y, Wang X, Xu T, Zhang Y, Xu J, Shu X
Vasc Endovascular Surg · 2025 Aug · PMID 40289333 · Publisher ↗
Objectivestudy aims to assess the clinical efficacy, technical features, and early follow-up outcomes of aortic arch dissection (AD) requiring left subclavian artery (LSA) reconstruction using the aorta arch stent-graft...
Objectivestudy aims to assess the clinical efficacy, technical features, and early follow-up outcomes of aortic arch dissection (AD) requiring left subclavian artery (LSA) reconstruction using the aorta arch stent-graft system combined with the endovascular needle system for in situ fenestration.Methods and ResultsEight patients with AD were enrolled in this clinical trial after rigorous screening between July 2021 and August 2022. The 8 patients who participated in this trial were male, with a mean age of 62.0 ± 8.3 years. The total operative time was 148.38 ± 35.06 minutes, and the mean hospitalization time was 11.4 ± 4.4 days. A total of 12 aortic stents were implanted in the 8 patients, and branching stents were implanted in the LSA in all patients. No cases of delayed endoleak occurred. There were no stent- or aorta-related deaths. The 2 deaths that did occur were confirmed to have been due to causes outside of the aorta and were unrelated to the thoracic endovascular aortic repair procedure, with a 1-year stent patency rate of 100%.ConclusionsWe believe that this trial of in situ fenestration achieved satisfactory early results, with reasonable postprocedural stent patency and patient survival, and there were no endoleaks requiring intervention during follow-up. However, long-term follow-up is needed to validate the findings of this trial.Trial registrationClinicalTrials.gov PRS Protocol Registration and Results System (URL: Home - ClinicalTrials.gov, NCT05126446).
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