Vascular And Endovascular Surgery[JOURNAL]
Sun
200 papers
Management of Popliteal Artery Interposition Graft Infection by Extra-anatomic Bypass.
Sheikh D, Timbalia S, Rahimi M
Vasc Endovascular Surg · 2025 Jul · PMID 40078122 · Publisher ↗
ObjectivesInfection of peripheral interposition grafts is a rare but devastating complication following aneurysm repair. Typically, graft infection necessitates explantation and, if possible, revascularization of the lim...
ObjectivesInfection of peripheral interposition grafts is a rare but devastating complication following aneurysm repair. Typically, graft infection necessitates explantation and, if possible, revascularization of the limb. However, treatment complexity varies substantially depending on the location and extent of infection. This case describes the management of a popliteal artery interposition graft infection.MethodsWe describe an 84 year old male with a history of left popliteal artery aneurysm repair with PTFE interposition graft (found on workup a year prior for a gangrenous great toe) who presented with four days of night sweats, chills, and a painful posterior left knee. Laboratory findings indicated leukocytosis, while ultrasound and CT imaging revealed complex fluid surrounding the graft without evidence of pseudo-aneurysm. Surgical management was conducted in two stages, the first with the patient supine for bypass from the superficial femoral artery to the posterior tibial artery using ipsilateral reversed great saphenous vein. The patient was then repositioned prone for the second stage of the procedure, and the infected popliteal fossa was entered posteriorly for debridement with caution to avoid injury to the tibial nerve and popliteal vein. The infected graft was removed, and antibiotic beads were placed in the infected region.ResultsFollowing this procedure and serial washouts one week later, the patient retained motor function, sensation, and palpable posterior tibial and dorsal pedal pulses. The patient was placed on IV cefazolin for 6 weeks following the procedure and discharged with 6 months of oral suppression to achieve long-term prevention of further infection.ConclusionsWhen managing popliteal artery graft infection, the presence of purulent material in the popliteal fossa can make anatomic bypasses high-risk for recurrent infection, and caution must be taken to avoid the nearby popliteal vein and tibial nerve during irrigation and debridement.
Asymptomatic Carotid Stenosis is Associated With Mobility Dysfunction: Results From the InChianti Study.
Desikan SK, Borrelli J, Gray VL … +3 more , Kankaria AA, Terrin M, Lal BK
Vasc Endovascular Surg · 2025 Jul · PMID 40017230 · Full text
BackgroundOlder adults with mobility dysfunction are at risk for falls, hospitalization, and death. In an earlier pilot study, individuals with asymptomatic carotid artery stenosis (ACAS) demonstrated mobility dysfunctio...
BackgroundOlder adults with mobility dysfunction are at risk for falls, hospitalization, and death. In an earlier pilot study, individuals with asymptomatic carotid artery stenosis (ACAS) demonstrated mobility dysfunction when compared to individuals without ACAS. We tested whether carotid stenosis affected mobility function in a larger community-dwelling cohort using the Invecchaire in Chianti (InCHIANTI) database.MethodsWe analyzed data from participants in the InCHIANTI study who completed a medical history, carotid duplex testing, and mobility function testing (Short Physical Performance Battery- SPPB). Participants with a history of stroke, transient ischemic attack, or carotid endarterectomy were excluded. 709 participants met inclusion criteria (116 ACAS, 593 no ACAS). Our analytic approach sought to evaluate the impact of stenosis on mobility after accounting for age, sex and cardiovascular risk factors. Age was stratified into 2 age-groups (65-74 and 75-84 years). Two-way ANOVA was used to test the effect of stenosis-group, age-group, and their interactions on SPPB score with sex as a covariate.ResultsStenosis-group ( = 0.0002), age-group ( < 0.0001), and the interaction between stenosis-group and age-group ( = 0.0008) significantly affected SPPB. Post-hoc testing showed that participants with ACAS demonstrated worse performance on the SPPB (9.81 ± 0.37) compared to those with no ACAS (11.10 ± 0.11) in the 65-74 years age-group ( 0.0001).Conclusions65-74-year-old adults with ACAS performed significantly worse on the SPPB than those without ACAS. These results lend further support that ACAS may be associated with mobility dysfunction in older adults.
Post-Stent Vein Lumen Shape and Clinical Response in Patients Treated for Iliofemoral Venous Occlusive Disease.
Gagne P, Kuku KO, Mendes R … +5 more , Griggs A, Segbefia E, Hofmann LV, Comerota A, Garcia-Garcia HM
Vasc Endovascular Surg · 2025 Jul · PMID 39965864 · Publisher ↗
ObjectiveInterventionalists have noted significant venous luminal gain with nitinol venous stents although post-placement lumen shape differed from the circular shape observed with elgiloy stents. The goal of this study...
ObjectiveInterventionalists have noted significant venous luminal gain with nitinol venous stents although post-placement lumen shape differed from the circular shape observed with elgiloy stents. The goal of this study was to determine the characteristics of a stented vein lumen that correspond with clinical outcomes, and to identify metrics that might be relevant for stent design by assessing aspect ratio (AR), lumen diameter (LD), lumen area (LA), and stent shape (symmetry and eccentricity) post-implant.MethodsThis post-hoc analysis evaluated patients from the VIVO US Study (NCT01970007) with pre- and post-stent intravascular ultrasound (IVUS) imaging. Patient characteristics, Venous Clinical Severity Score (VCSS) and Venous Disability Score (VDS) were collected in the study. LD, LA, and stent geometry were measured by the core laboratory. Data were analyzed for linear association between core-laboratory assessed pre and post stent LD, LA, AR, stent eccentricity and symmetry index, and VCSS and VDS change.ResultsIVUS imaging was available for 29 patients (2 sites) enrolled in the VIVO US Study (55.2% women; mean age: 59.8 ± 17 years). The cohort had post-thrombotic (48.3%), nonthrombotic iliac vein lesion (44.8%) or acute deep vein thrombotic (6.9%) disease. Mean lesion length was 111.8 ± 60.9 mm. Eleven stents extended below the inguinal ligament. Median minimum LD and LA significantly increased after stent placement ( < 0.001); median lumen AR changed from 2.0 pre-stent to 1.4 post-stent ( < 0.001). Mean VCSS improved from baseline to 12 months (7.6 ± 4.3 to 3.7 ± 2.6). No statistically significant linear relationships were identified between VCSS / VDS change and a specific characteristic of LA, LD, or AR.ConclusionsMeasures of lumen change pre and post iliofemoral vein nitinol stent placement reflect disease and stent characteristics. After stent placement, minimum LD and LA increased and AR decreased. Stented lumen shape or size with Zilver Vena did not impact 1-year clinical improvement by VCSS.
Disparities in Aortic Aneurysm Mortality Trends: Revealing Sex and Racial Inequalities.
Azuma M, Ramirez A, Moser GW … +4 more , Oh KJ, Kashem MA, Toyoda Y, Mokashi S
Vasc Endovascular Surg · 2025 Jul · PMID 39951651 · Publisher ↗
BackgroundAbdominal aortic dissection or aneurysm (AAA) is a significant health concern in developed nations often underdiagnosed with poor outcomes. Despite a decline in aortic dissection and aneurysm mortality rates in...
BackgroundAbdominal aortic dissection or aneurysm (AAA) is a significant health concern in developed nations often underdiagnosed with poor outcomes. Despite a decline in aortic dissection and aneurysm mortality rates in the US from 1999 to 2020, reported by the CDC, this improvement disproportionately favors males and Caucasians. This study aims to elucidate these disparities.MethodsData from the CDC Wonder database from 1999 to 2020 on aortic aneurysm, including abdominal, thoracic, and thoracoabdominal aneurysms and rupture related deaths in the US were analyzed. Mortality rates were compared across sex, race, and geographic location separated by state. Mortality was normalized based on population and analyzed with linear regression models with all plots showing goodness of fit.ResultsOverall, the mortality gap between male and female cohorts with aortic aneurysm-related deaths widened by 0.57 per 100,000 deaths per year ( < 0.001). Mortality between Caucasians with African American and Asian American cohorts showed reductions of 0.41 per 100,000 per year ( < 0.001). Caucasian and male cohorts started at higher mortality rates when compared to their competitive cohorts.ConclusionsDespite a reduction in mortality rates among individuals with aortic aneurysm in the US from 1999 to 2020, this decline disproportionately benefits males and Caucasians over African American and Asian populations. Although Caucasians and males had higher mortality in 1999, their decline is significantly greater. Following current trends, Caucasian and male mortalities will be lower than minority groups by 2026. Targeted interventions are needed to address these disparities effectively.
Is There a "Weekend Effect" on In-Hospital Outcomes of Type a Aortic Dissection Repair? A Population-Based Analysis of National Inpatient Sample From 2015-2020.
Li R, Huddleston SJ
Vasc Endovascular Surg · 2025 Jul · PMID 39946543 · Publisher ↗
Background"Weekend effect" in type A aortic dissection (TAAD) repair has been identified in several countries where weekend admission is associated with higher mortality rates. However, in the US, findings have been mixe...
Background"Weekend effect" in type A aortic dissection (TAAD) repair has been identified in several countries where weekend admission is associated with higher mortality rates. However, in the US, findings have been mixed regarding the "weekend effect" on TAAD outcomes. This study aimed to conduct a comprehensive, population-based analysis of the association between weekend admission and the in-hospital outcomes of TAAD repair using a large-scale national registry.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients admitted on the weekend vs weekday, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status were adjusted.ResultsThere were 1007 and 3275 patients who underwent TAAD repair under weekend and weekday admission, respectively. Patients admitted on the weekend were more likely to get transferred in from a different acute care hospital and have renal malperfusion. After multivariable analysis, patients admitted on the weekend and weekday had comparable times from admission to operation (0.88 ± 2.64 vs 0.92 ± 2.99 days, = 0.64) and in-hospital mortality (15.99% vs 14.84%, aOR = 1.119, 95 CI = 0.914-1.37, = 0.28). All other in-hospital outcomes, hospital length of stay, and total hospital charge were similar between the 2 cohorts.ConclusionPatients admitted on weekends and weekdays had comparable times from admission to operation, as well as similar in-hospital mortality and morbidities. These findings suggest the effectiveness of weekend emergency care protocols for TAAD patients and the lack of a "weekend effect" on TAAD repair in the United States.
Preservation of Blood Flow to the Internal Iliac Artery Using a Custom-Made Single Fenestrated Endograft: A Case Report.
Shakery S, Nio D, Truijers M
Vasc Endovascular Surg · 2025 May · PMID 39934641 · Full text
PurposeThis report describes the use of a custom-made single-fenestrated endograft to preserve blood flow to the internal iliac artery (IIA) in a patient with an aorto-iliac aneurysm with unsuitable anatomy for a standar...
PurposeThis report describes the use of a custom-made single-fenestrated endograft to preserve blood flow to the internal iliac artery (IIA) in a patient with an aorto-iliac aneurysm with unsuitable anatomy for a standard iliac branch device (IBD).Case ReportA 56-year-old man presented with an abdominal aortic aneurysm (AAA) of 56 mm involving the right common iliac artery (CIA). Use of a standard IBD for preservation of the IIA was deemed impossible due to narrow arrow anatomy of the right CIA. To preserve IIA flow, a custom-made Terumo endograft with an additional single-fenestration for the IIA was designed. The repair was successful and flow to the right IIA was preserved.ConclusionUsing a custom-made single-fenestrated endograft for the IIA in case of unsuitable anatomy for off-the-shelf IBDs prevents exclusion of the IIA and might prevent complications like buttock claudication and erectile dysfunction in patients with an aorto-iliac aneurysm. This report describes the use of a custom-made single fenestrated endograft to preserve blood flow to the IIA as a valuable alternative to standard iliac branched repair in patients with anatomical challenges.
Successful Surgical Management of Giant, Shamblin III Carotid Body Tumor (CBT) on a Male With 5 Years of Follow-Up: Case Report and Literature Review on Giant CBT.
Ruvalcaba-Guerrero H, Anaya-Ayala JE, Martín-Dorantes MA … +5 more , Santos-Chávez EE, Serrano-Heredia JS, Andrade-Orozco G, Martínez-Benítez B, Hinojosa CA
Vasc Endovascular Surg · 2025 May · PMID 39790092 · Publisher ↗
BackgroundCarotid body tumor (CBT) is a rare neoplasm that arises from the chemoreceptor cells located at the carotid bifurcation. Giant CBTs are extremely rare, with only 16 cases reported to date.Case SummaryA 63-year-...
BackgroundCarotid body tumor (CBT) is a rare neoplasm that arises from the chemoreceptor cells located at the carotid bifurcation. Giant CBTs are extremely rare, with only 16 cases reported to date.Case SummaryA 63-year-old male with an unremarkable medical history presented with a right-sided, giant, Shamblin III CBT. For 20 years, he had been suffering from progressive dyspnea, dysphonia, and pain with left neck rotation. A computed tomography scan confirmed its dimension of 89 × 61 × 60 mm (height × width × depth). We performed our routine retrocarotid dissection technique (RCDT) without preoperative embolization. Histopathology reported an encapsulated, non-epithelial neuroendocrine neoplasm with architectural pattern. His postoperative period was uneventful and was discharged home on day 2. At 5 years, he remains symptom-free without neoplasm recurrence.ConclusionThis case illustrates the atypical clinical presentation and the successful treatment of a giant, Shamblin III CBT with the RCDT without preoperative embolization.
Open Distal Venous Arterialization Technique as an Opportunity for Patients With Critical Limb Ischemia: A Latin American Experience.
Randial-Pérez LJ, Portilla-Rojas E, Pinzón-Pinto M … +4 more , Suárez-Gómez SA, Amorocho-Suárez M, Contreras C, Cabrera-Vargas LF
Vasc Endovascular Surg · 2025 May · PMID 39757475 · Publisher ↗
BackgroundChronic limb-threatening ischemia (CLTI) leads to decreased quality of life and increased disease burden, resulting in progressive patient deterioration, limb amputation, and mortality.ObjectivesThis study aims...
BackgroundChronic limb-threatening ischemia (CLTI) leads to decreased quality of life and increased disease burden, resulting in progressive patient deterioration, limb amputation, and mortality.ObjectivesThis study aims to present the outcomes of a Latin American experience using the open distal venous arterialization (DVA) technique for no-option limb salvage in a high volume CLTI center.MethodsA retrospective case series study was performed including patients from 2018 to 2022 using a population from Bogotá, Colombia. Patients with no-option chronic limb-threatening ischemia underwent open DVA with a 12 month follow-up period. Variables such as operative time, hospital and ICU length of stay, graft material, re-interventions, 1-year patency, amputations and 1-year mortality were recorded.Results5 patients with a mean age of 71 years were intervened. 60% were male and 80% had a diabetes mellitus diagnosis. Four patients underwent a reverse great saphenous vein graft procedure and 1 composite polytetrafluoroethylene graft. A total of 80% of patients demonstrated graft patency after 1 year. No perioperative mortalities were recorded but one late postoperative mortality due to myocardial infarction occurred. One major amputation was required, minor amputations were performed in 2 of the patients.ConclusionOpen DVA is a feasible low cost technique for adequately selected patients with favorable saphenous vein, as evidenced by the limb salvage and graft patency outcomes.
Midterm Results of the STABILISE Technique in the Treatment of Aortic Dissection.
Eidt JF, Cha E, Hohmann S … +1 more , Vasquez J
Vasc Endovascular Surg · 2025 May · PMID 39724017 · Publisher ↗
: Contemporary treatments of acute aortic dissection, including medical, surgical, and endovascular options, are remarkably effective at the management of malperfusion and rupture. Unfortunately, long-term studies indica...
: Contemporary treatments of acute aortic dissection, including medical, surgical, and endovascular options, are remarkably effective at the management of malperfusion and rupture. Unfortunately, long-term studies indicate that 30%-50% of patients need secondary procedures to treat progressive aneurysmal enlargement of the untreated aorta. The Stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) technique was introduced to improve long-term outcomes. : This study aims to investigate the results of the STABILISE technique in patients with aortic dissection. : This is a single-center, retrospective review of all patients treated with the STABILISE technique. There were 12 de novo type B aortic dissection (TBAD) and 7 residual TBAD following type A aortic dissection (TAAD) repair. : There was disruption of the dissection membrane and relamination in all or part of the bare metal stent segment in 100% of cases. The average percent attainment of a uni-luminal aorta in comparison to the length with persistent false lumen was 91 ± 12%. : Midterm results suggest that the STABILISE technique may improve aortic remodeling after endovascular treatment of acute dissection.
Sonography-Guided Endovascular Retrieval of Fractured Angiocatheter in Brachial Artery: A Case Report.
Chen YY
Vasc Endovascular Surg · 2025 May · PMID 39568294 · Publisher ↗
BackgroundThe insertion of an angiocatheter into a peripheral artery for continuous hemodynamic monitoring is a widely employed clinical practice. Fracture of a angiocatheter retained in an artery, though infrequent, pre...
BackgroundThe insertion of an angiocatheter into a peripheral artery for continuous hemodynamic monitoring is a widely employed clinical practice. Fracture of a angiocatheter retained in an artery, though infrequent, presents a challenge in clinical management, particularly in critically ill patients. Surgical exploration for retrieval is generally required, as fluoroscopy-guided endovascular methods are precluded due to the radiolucency of catheters.Case reportThis case report demonstrates the successful retrieval of a fractured catheter from the brachial artery of an 85-year-old critically ill patient through the utilization of endovascular techniques guided by sonography. Key considerations include selecting an appropriate snare system diameter and ensuring real-time sonographic visualization to prevent displacement of the fractured segment.ConclusionThis case illustrates the feasibility and safety of sonography-guided endovascular retrieval as an alternative to surgical intervention for fractured angiocatheters. The proposed strategy demonstrates its applicability in similar clinical scenarios.
Functional Outcomes and Complications of Carotid Tandem Lesions After Mechanical Thrombectomy for Treatment of Large-Vessel Occlusion Stroke.
Scott C, Abdulrahman L, Snyder M … +4 more , Castillo L, Lu J, Dunlap E, Nagarsheth K
Vasc Endovascular Surg · 2025 May · PMID 39565776 · Publisher ↗
BackgroundLarge Vessel Occlusion (LVO) stroke patients with tandem lesions (TLs) have been observed to have worse outcomes when compared to patients with simple isolated intracranial occlusions.ObjectiveTo examine the di...
BackgroundLarge Vessel Occlusion (LVO) stroke patients with tandem lesions (TLs) have been observed to have worse outcomes when compared to patients with simple isolated intracranial occlusions.ObjectiveTo examine the difference in post-operative functional status at discharge for patients treated with mechanical thrombectomy for an acute LVO stroke based on the presence of a tandem carotid lesion.MethodsThis is a retrospective cohort study of 589 patients presenting within the first 24 hours of stroke onset who underwent mechanical thrombectomy. The primary outcome was functional status quantified by modified Rankin Score (mRS) at time of discharge. The secondary outcomes were presence of hemorrhagic conversion, midline shift >5 cm, malignant cerebral edema, reocclusion, Thrombolysis in Cerebral Infarction Scale (TICI), and discharge location.ResultsPatients with tandem occlusions and those with isolated intracranial lesions had similar baseline demographics. However, in patients with TLs, there was a significantly higher NIH stroke scale at admission and a longer time to recanalization. Modified Rankin Score prior to admission was similar for both groups, but was significantly higher in patients with TLs at discharge. The secondary outcomes were similar for hemorrhagic conversion, discharge to hospice, and a TICI scale of 0, but were significantly worse for patients with TLs for in-hospital mortality, midline shift >5 mm, and malignant cerebral edema. The presence of a tandem lesion predicted a higher modified Rankin Score at discharge in univariate regression modeling (β = .45; -value = .006).ConclusionThe two groups were similar in baseline characteristics and cardiovascular risk factors, yet patients with tandem carotid lesions experienced more complications during their hospitalization and had greater functional disability at discharge. Patients with a TL had a longer mean time to recanalization, representing a potential explanation for these differences in outcomes.
Association of Frailty Index and Postoperative Outcomes of Open Bypass Lower Extremity Revascularization for Acute Limb Ischemia Using the Vascular Quality Initiative.
Gonzalez M, Paz M, Babrowski T
Vasc Endovascular Surg · 2025 May · PMID 39562847 · Publisher ↗
BackgroundFrailty in patients undergoing surgery is strongly associated with postoperative complications. The risk analysis index (RAI) is a validated model for frailty that has been shown to predict short and long-term...
BackgroundFrailty in patients undergoing surgery is strongly associated with postoperative complications. The risk analysis index (RAI) is a validated model for frailty that has been shown to predict short and long-term outcomes. Through utilization of the Vascular Quality Initiative (VQI), this study examined the application of the VQI-derived RAI in acute limb ischemia (ALI) patients undergoing open bypass lower extremity revascularization.MethodsThis is a longitudinal retrospective cohort study conducted on patients undergoing revascularization for ALI from the VQI. Using preoperative variables, an RAI score was calculated for each patient, and they were stratified into six cohorts: ≤20, 21-25, 26-30, 31-35, 35-40, and ≥41. A binary forward multivariate logistic regression was used to determine the risk in each cohort on postoperative outcomes (mortality, amputation, surgical site infection, bypass revision, and discharge destination).ResultsThe VQI dataset included 3,620 patients (72.1% male) with an average age of 65 ± 12 years. After conducting a binary forward multivariate logistic regression, frailty was not associated with amputation, surgical site infection, or bypass revision. However, frailty at the highest vs lowest RAI score was significantly associated with 3.26 higher times the odds of mortality and 0.32 lower times the odds of being discharged home.ConclusionFrailty, modeled by the RAI, was demonstrated to be associated with postoperative outcomes in a linear manner in ALI patients undergoing open bypass lower extremity revascularization. Since this is one of the first times a long-term outcomes national database such as the VQI was utilized to study this topic, our research supports the incorporation of the RAI as a screening tool for ALI patients to help guide postoperative care and prognosis and guide shared decision-making in whether to pursue limb salvage or primary amputation.
Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers.
Zhang J, Sadek M, Iannuzzi L … +8 more , Rockman C, Garg K, Taffet A, Ratner M, Berland T, Maldonado T, Jacobowitz G, Ross F
Vasc Endovascular Surg · 2025 May · PMID 39530741 · Publisher ↗
ObjectivesTotal contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort...
ObjectivesTotal contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD).MethodsThis was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention.Results152 patients underwent TCC. Mean age was 58.8 ± 12.1 years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9 cm, with mean depth 0.61 ± 0.49 cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1 days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, < .001), intervention (43.4% vs 17.8%, = .006), and noncompliance (39.1% vs 20.2%, = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, < .0001) and incompressible vessels (36.4% vs 7.6%, < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, = .0008) compared to patients without intervention.ConclusionsTCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.
Endovascular Repair of Primary Aortocaval Fistula at the Caval Confluence in a Ruptured Abdominal Aortic Aneurysm.
Williams ZE, Choudhry A, Rahman NA … +2 more , Chihade DB, Surowiec SM
Vasc Endovascular Surg · 2025 May · PMID 39526864 · Publisher ↗
Primary aortocaval fistulas (ACF) are a rare complication of abdominal aortic aneurysm (AAA), for which treatment options encompass both endovascular and open surgical intervention. To report a rare presentation of prim...
Primary aortocaval fistulas (ACF) are a rare complication of abdominal aortic aneurysm (AAA), for which treatment options encompass both endovascular and open surgical intervention. To report a rare presentation of primary aortocaval fistula. Case Report. Single Patient Case. Single case report. We present a 54-year-old male with a ruptured AAA and associated ACF uniquely located near the caval confluence which was managed through primary endovascular exclusion. Notably, we report significant migration of our graft upon deployment, due to high flow through the ACF. Following a literature review on ACFs, we remark on the anatomic challenges regarding management of an ACF. Awareness of the clinical signs and symptoms remains imperative in proper ACF management given its high mortality.
The 'DIMPLE SIGN' of Intra-Aortic Cord.
Puppala S, Tingirides C, Forsyth J
Vasc Endovascular Surg · 2025 May · PMID 39498639 · Full text
BackgroundWith increasing use of imaging to diagnose human pathology, newer aortic anomalies are being identified. An intra-aortic cord is one such abnormality, which requires differentiating from an intimal flap of diss...
BackgroundWith increasing use of imaging to diagnose human pathology, newer aortic anomalies are being identified. An intra-aortic cord is one such abnormality, which requires differentiating from an intimal flap of dissection, to avoid major surgery or prolonged surveillance. The aim of this study was to bring forth a unique feature of the intra-aortic cord on imaging, using volume rendering reformatting and identify similar findings in published literature and hence establish the role of the 'Dimple' sign.MethodsReview of both our institutional imaging (2 cases) as well as the published literature (6 cases), to identify presence of a diagnostic sign that is seen on volume rendered imaging of aorta.ResultsThe 'Dimple sign' is unique to the intra-aortic cord and is noted on the images of 4 out of 6 prior publications. Two publications did not use volume rendering. Including our cases, the Dimple' sign is seen in 6 out of 8 cases. The Dimple sign arises due to tethering of the cord to the aortic wall leading to umbilication of the aortic wall inwards.ConclusionsThe Dimple sign can be very easily noted on volume and/or cinematic rendering and is a useful sign to diagnose an intra-aortic cord and help differentiate it from an intimal flap.
Insurance and Structural Access Quality and Effects on AAA Mortality: A National Healthcare Quality and Disparities Report Analysis.
Ramirez A, Azuma M, Popov AF … +3 more , Schmitto JD, Moser GW, Mokashi S
Vasc Endovascular Surg · 2025 May · PMID 39472364 · Publisher ↗
BackgroundThe National Health care Quality and Disparities Report (NHDQR) presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, a...
BackgroundThe National Health care Quality and Disparities Report (NHDQR) presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. This study aims to determine the significance of insurance quality and access to care on AAA repair outcomes.MethodsData was obtained through the Agency for Health care Research and Quality database from 2016-2020. AAA repair mortality rates per 1000 persons, insurance quality, and structural access were compared between the 31 reportable U.S. states in which data was analyzed using linear regression models and ANOVA. Insurance quality and structural access groups were categorized as weak, average, and strong, based on NHDQR Reports measures.ResultsNo association was found between access to care and AAA mortality at specific time points (2016 and 2020; -value = .90 and .29 respectively) and when comparing states that showed improvement from 2016 to 2020 (weak categorization to strong; value = .27). An association was found between private insurance quality and AAA repair mortality at baseline (2016; -value = .022) and in those that showed improvement or worsening in private insurance quality over the study period (-value = .042).ConclusionsOur findings suggest that there is no association between structural access quality and AAA mortality although an association exists between AAA mortality and private insurance quality.
A New Technique for Creation of Femoral Vein Monocusp Neovalve for Patients With Primary Deep Vein Incompetence.
Sekar N, Rajan A, Sima R
Vasc Endovascular Surg · 2025 May · PMID 39460449 · Publisher ↗
Chronic venous insufficiency due to deep vein incompetence (DVI) is difficult to treat and is prone for failure and recurrence of venous ulcers. A variety of techniques have been tried to create valve competency but majo...
Chronic venous insufficiency due to deep vein incompetence (DVI) is difficult to treat and is prone for failure and recurrence of venous ulcers. A variety of techniques have been tried to create valve competency but majority of them have been difficult to perform and have not shown long term results. Opie reported a technique for construction of a monocusp neo valve. We have modified this procedure and successfully corrected the deep vein reflux in a patient with primary DVI.MethodsMonocusp valve was created by folding the vein wall flap so that both sides of the valve will have intimal surface.ResultPatient had excellent symptomatic improvement. The venous ulcer healed with skin grafting and had not recurred at 30 months follow up. Descending venogram and duplex scan showed mild reflux.ConclusionMonocusp neo valve creation for primary DVI is a simple procedure with good long-term result.
Ruptured Complex Aortoiliac Aneurysm in an Elderly Patient With a Kidney Transplant Presenting With Sciatica.
Kostiuk V, Rodriguez PP, Aboian E … +3 more , Kuwayama DP, Guzman RJ, Ochoa Chaar CI
Vasc Endovascular Surg · 2025 May · PMID 39438778 · Publisher ↗
Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increase...
Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increases significantly to 29% once the aneurysm reaches 4 cm. Similarly to abdominal aortic aneurysms, common iliac artery aneurysms often develop silently, remaining asymptomatic in about 70% of cases. This report describes the treatment of a patient with a kidney transplant who underwent endovascular repair of a ruptured left common iliac artery aneurysm with a concomitant abdominal aortic aneurysm and a focal aneurysm of the right renal artery origin. A 78-year-old male patient with a kidney transplant presented with left sciatica symptoms and was found to have a contained rupture of a 10 x 7 cm left common iliac artery aneurysm with a concomitant 8 cm abdominal aortic aneurysm and a focal 1.8 cm aneurysm of the right renal artery origin. He underwent an endovascular aneurysm repair with an Aorto-Uni-iliac stent graft and a concomitant right-to-left femoral-femoral bypass using 8 mm ringed PTFE graft and ligation of left external iliac artery to prevent retrograde flow into the left common iliac artery aneurysm. At 3-year follow-up, patient remains stable with a functioning kidney transplant and excluded aneurysms with no evidence of endoleak. This report describes the endovascular repair of a ruptured left common iliac artery aneurysm conducted under local anesthesia in a patient with a renal transplant and complex aneurysm anatomy. The calcification pattern observed on a non-contrast CT scan was effectively used for surgical planning, leading to a successful aneurysm repair while preserving kidney transplant function.
Blunt Thoracic and Abdominal Aortic Injury in Multiple Trauma: A Case Report.
Akinaga S, Maruhashi T, Oi M … +3 more , Mishima T, Miyaji K, Asari Y
Vasc Endovascular Surg · 2025 May · PMID 39437127 · Publisher ↗
BackgroundBlunt abdominal aortic injury (BAAI) is rare among traumatic aortic injuries, and further complications of blunt thoracic aortic injury (BTAI) have never been reported.Case PresentationA man in his 80s presente...
BackgroundBlunt abdominal aortic injury (BAAI) is rare among traumatic aortic injuries, and further complications of blunt thoracic aortic injury (BTAI) have never been reported.Case PresentationA man in his 80s presented to our hospital following a motor vehicle accident. Pan-scan contrast-enhanced CT showed a thoracic aortic isthmus injury (Grade III), an abdominal aortic injury (Grade IV) with extravasation of contrast media at the level of the fourth lumbar vertebra. Endovascular abdominal aortic repair was performed on the same day and a thoracic endovascular aortic repair for BTAI was performed 11 days after admission. The patient had a good postoperative course and was discharged without complications.ConclusionThis report presented a rare case of BTAI complicated with BAAI. The timing of intervention for aortic injury should be determined based on urgency and other organ damage.
Incidence of Compartment Syndrome Following Peri-Pandemic Intervention for Non-traumatic Acute Limb Ischemia.
Chihade DB, Williams ZE, Wainwright BS … +1 more , Shaw PM
Vasc Endovascular Surg · 2025 May · PMID 39436212 · Publisher ↗
ObjectiveDuring the pandemic, our institution anecdotally observed a significant proportion of acute limb ischemia (ALI) patients developing compartment syndrome (CS) following revascularization compared to pre-pandemic...
ObjectiveDuring the pandemic, our institution anecdotally observed a significant proportion of acute limb ischemia (ALI) patients developing compartment syndrome (CS) following revascularization compared to pre-pandemic rates. To determine whether this perceived increase was occurring globally, we utilized the TriNetX database to evaluate the incidence of CS secondary to ALI intervention in both the pre-pandemic (2017-2019) and pandemic eras (2020-2022).MethodsWe conducted a multicenter query using the TriNetX global research network for ALI patients receiving treatment. Incidence of CS diagnosis within 1 calendar day of ALI intervention was calculated for each era. Demographics and comorbidities were then compared between CS and non-CS patients within each era. Risk of adverse outcomes within 30 days of CS diagnosis was also determined for each era, including mortality, major amputation, and re-intervention.ResultsThe pre-pandemic cohort contained 7736 patients while the pandemic era cohort included 8,306, for 16,042 total patients. A significant increase in CS incidence (risk ratio (RR) = 1.23, = 0.0026) was demonstrated within the pandemic era. An increased prevalence of comorbidities such as dyslipidemia (pre-pandemic: = 0.0022; pandemic: = 0.0026) and peripheral vascular disease ( < 0.0001, both eras) was observed in the non-CS cohort within both eras. 30-day mortality was significantly increased in CS patients (pre-pandemic: RR = 3.057; pandemic: RR = 2.710; < 0.0001 both eras) compared to non-CS patients. CS patients were more likely to receive major amputation (pre-pandemic: RR = 3.734; pandemic: RR = 2.809; < 0.0001 both eras) and/or re-intervention within 30 days (pre-pandemic: RR = 1.871, < 0.0001; pandemic: RR = 1.370, = 0.0218) over non-CS patients.ConclusionsThe incidence of CS following revascularization for ALI rose worldwide during the pandemic. Patients who developed CS are younger with fewer comorbidities than non-CS patients. Despite a more favorable comorbid profile, CS patients demonstrate significantly higher rates of adverse outcomes. Further investigation is necessary to determine the specific underlying mechanisms driving this increased incidence in CS among ALI patients.
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