Department Of Vascular Surgery Research Articles

Direct Oral Anticoagulants (DOACs) vs VKA (Vitamin K antagonist oral anticoagulants) in DVT - Our Experience at the Department of Vascular Surgery, King George’s Medical University, Lucknow, India

Direct Oral Anticoagulants (DOACs) vs VKA (Vitamin K antagonist oral anticoagulants) in DVT - Our Experience at the Department of Vascular Surgery, King George’s Medical University, Lucknow, India

The Association between Major Adverse Cardiovascular Events and Peripheral Artery Disease Burden

Objective: The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). Methods: All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system. Results. The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4–6.5) and for MACEs overall (OR 2.3; 95%CI 1.4–3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6–8.0 for HF and an OR 3.1; and 95%CI 1.7–5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6–3.2) and MACE (OR 1.9; 95%CI 1.3–2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs. Conclusions: PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased.

Results of open prosthetics of abdominal aortic aneurysms using laparotomic and retroperitoneal approaches

The OBJECTIVE was to evaluate the results of surgical treatment of abdominal aortic aneurysm using laparotomic and retroperitoneal approaches.METHODS AND MATERIALS. The study included 206 patients operated on at the Department of Vascular Surgery of the Novgorod Regional Clinical Hospital from 2010 to 2018. All patients were divided into 2 groups. The first – 112 people, whose surgical intervention was performed through laparotomic approach. The second – 94 patients, approach to the aorta was made by the retroperitoneal technique according to Rob. comparison of non-specific life-threatening complications included the development of myocardial infarction and acute cardiovascular failure, acute respiratory distress syndrome and respiratory failure, the development of ischemic colitis and small bowel obstruction, which required repeated interventions. The development of acute renal injury was characterized as an increase in creatinine by 50 % from baseline or a decrease in glomerular filtration rate (GFR) by more than 25 %. This group of complications also included ischemic stroke, sepsis, and multiple organ failure. Wound complications included insolvency of postoperative wounds of retroperitoneal and laparotomic approaches, cases of eventration.RESULTS. When analyzing the incidence of nonspecific complications, it was found that in group I their frequency was 41 (46.6 %) clinical cases, and in group II – 26 (27.6 %) (p=0.173*). In group I, the incidence of cardiovascular complications significantly exceeded those in group II – 17 (15.2 %) vs 6 (6.4 %) (p*=0.046). The incidence of gastrointestinal complications was also significantly higher in group I – 9 (8 %) vs 1 (1.06 %) (p*=0.021). The frequency of deaths in groups I and II did not differ significantly in 7 (6.25 %) and 5 (5.3 %) cases (p*=0.77).CONCLUSION. As our study showed, retroperitoneal approach is a worthy alternative to laparotomy, mainly in case of repeated interventions, as well as in the presence of signs of visceral obesity of the patient. At the same time, laparotomic approach is associated with a higher risk of developing cardiovascular and gastrointestinal complications in the treatment of abdominal aortic aneurysms.

A fluctuating intensity of care: A qualitative study on the experiences of informal caregivers of patients with critical limb-threateningischemia.

Informal caregivers play a significant role in providing care for older, often vulnerable, patients, and supporting them as they live with chronic diseases. Due to the rising prevalence of older vascular patients and their use of healthcare, the role of their informal caregivers will become more important. However, little is known about the experiences of informal caregivers of patients with critical limb-threatening ischemia and the impact of informal care on different aspects of these caregivers' lives. In addition, literature does not describe the burden this role brings with it, or lack thereof. Therefore a qualitative study using a phenomenological approach, specifically interpretive phenomenological analysis, was used to gain insight into the experiences of the primary informal caregivers of patients with chronic limb-threatening ischemia. Data were collected via semi-structured interviews and focus groups discussions. Fifteen primary informal caregivers of patients with critical limb-threatening ischemia under the care of the vascular surgeon at a tertiary teaching hospital in the Netherlands were included. Data analysis yielded three themes: the perceived identity of this group of caregivers; the varying intensity of informal care; and the collaboration between informal carers, their care recipients and the professional care provider within the vascular surgery department. In contrast to carers of other chronic diseases, the shifting intensity of care that informal caregivers of critical limb-threatening ischemia patients experience seems to prevent long-term overload. Adapting to that fluctuating situation requires flexibility from healthcare providers within the vascular surgery department. In addition, professionals need to involve informal caregivers in the patient's decision-making process and recognize their role in that process.

Endovascular treatment for Stanford type B aortic dissection in Marfan syndrome patients: a series of 23 cases

Objective: To evaluate the clinical outcomes of thoracic endovascular aortic repair (TEVAR) in the treatment of Stanford type B aortic dissection (TBAD) in Marfan syndrome patients who had no history of aortic arch replacement. Methods: This is a retrospective case-series study. From January 2009 to December 2019,the clinical data of Marfan syndrome patients who underwent TEVAR for TBAD at the Department of Vascular Surgery were collected. A total of 23 patients were enrolled,including 15 males and 8 females. The age was (38.0±11.0) years (range:24 to 56 years). Among them,12 patients had history of ascending aortic surgery. Details of TEVAR,perioperative complications and reintervention were recorded and survival rate was analyzed by Kaplan-Meier curve. Results: Technical success was 91.3% (21/23). Two patients with technical failure were as follows:one patient had type Ⅰa endoleak at the completion angiography,which healed spontaneously during the follow-up,and the other patient suffered aortic intimal intussusception after the deployment of the first stent-graft, and the second stent-graft was deployed. However, type Ⅲ endoleak was detected,which disappeared during the follow-up. One patient died during hospitalization. The median follow-up time (M(IQR)) was 60 (48) months (range:12 to 132 months). Reintervention was performed on 7 patients,including 3 distal stent-graft-induced new entry,2 distal aortic dilation,1 Ⅰa endoleak and 1 retrograde type A aortic dissection,respectively. Five-year cumulative survival rate was 86.7% (95%CI:86.6% to 86.8%) and the 5-year freedom from reintervention rate was 81.8% (95%CI:61.8% to 92.8%). Conclusions: TEVAR is feasible in the treatment of TBAD in Marfan syndrome patients who has no history of aortic arch replacement. It has high technical success rate and low perioperative complication.

Left-Sided Pneumothorax in a Potential Kidney Transplant Recipient—A Surprise in the Surgical Ward: Case Report

The risk of morbidity and mortality in the group of people qualified for kidney transplantation is high. Although currently, the qualification for kidney transplantation is very extensive and detailed, the final examination and assessment at the transplant center is crucial for the success of the transplantation. A 50-year-old woman with end-stage kidney disease was admitted to the Department of General, Vascular, and Transplant Surgery on July 21, 2023, for kidney transplantation. A month earlier, she had undergone surgery to create an arteriovenous fistula on the left forearm. The regional anesthesia was performed. Apart from temporary pain and cough, the postoperative course was uncomplicated. Upon admission to the Department, the patient was in good general condition, and only a dry cough was noted during the physical examination. Chest X-ray revealed pneumothorax on the left side with partial lung atelectasis. The patient was temporarily disqualified from kidney transplantation and the pneumothorax was cured. She is currently on the active list waiting for a kidney transplant. The analysis of the above case emphasizes the importance of a physical examination and final qualification at the transplant center. Detailed examination and evaluation at the above center can improve patients' quality of life and survival.

Open Withdrawal of Inferior Vena Cava Filter. Experience of 5 Cases in the Department of Angiology, Vascular and Endovascular Surgery of the Ignacio Chavez National Institute of Cardiology

Open Withdrawal of Inferior Vena Cava Filter. Experience of 5 Cases in the Department of Angiology, Vascular and Endovascular Surgery of the Ignacio Chavez National Institute of Cardiology

Stężenie substancji P związane jest z odpowiedzią zapalną i odczuwaniem bólu u pacjentów z bólem przewlekłym w przebiegu choroby niedokrwiennej kończyn dolnych

Previous studies indicate a significant role of the inflammatory response in the etiopathogenesis of peripheral artery disease (PAD) and chronic pain (CP). The aim of the study was to determine the relationship between the concentration of SP and the level/concentration of inflammatory mediators (pro-inflammatory cytokines, positive and negative acute phase protein, anti-inflammatory cytokines) and pain intensity in people suffering from chronic pain (CP) in the course of PAD. We examined 187 patients of the Department of Vascular Surgery. 92 patients with PAD and CP (study group) were compared to 95 patients with PAD without CP (control group). The relationship between SP and the level/concentration of fibrinogen, C-Reactive Protein (CRP), antithrombin III (AT), serum albumin, Interleukin 10 (IL-10), Tumor Necrosis Factor Alpha (TNF-α) and pain intensity (NRS) was analyzed. Statistical analysis was performed using the R program, assuming the level of statistical significance α=0.05. Patients with CP had significantly higher levels of fibrinogen (p<0.001), CRP (p<0.001), SP (p<0.001), IL-10 (p<0.001) and lower serum albumin levels (p<0.023). Higher SP concentration was associated with higher levels of IL-10, CRP and pain intensity. In both groups, SP concentration correlated negatively with the level of fibrinogen (p<0.001) as well as with albumin in the control group (p<0.001). Thus, there is a relationship between the concentration of SP and fibrinogen, along with CRP, IL-10 and the intensity of pain in people suffering from CP in the course of PAD and the level of albumin in the group without CP.

The effect of the ratio of aneurysm sac diameter to patient age on the long-term efficacy of different surgical methods for infrarenal abdominal aortic aneurysm

Objective: To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA). Methods: This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R,and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher 's exact test was used for categorical variables,and t test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results: After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%,P<0.05),complication rate (44.7% vs.26.3%,P<0.05), and secondary intervention rate (31.6% vs.13.2%,P<0.05) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%,P<0.05),complication rate (28.6% vs.35.7%,P>0.05) and secondary intervention rate (14.3% vs.21.4%, P>0.05) between the two groups. Conclusions: When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

Initial experience of endovascular aneurysm repair at the Dr. Eduardo Liceaga General Hospital of Mexico

Background: Abdominal aortic aneurysm (AAA) is the permanent and irreversible dilation of the lower part of the aorta where the vessel expands, making it susceptible to rupture, which represents a high mortality incident. Methods: A review of clinical records was carried out from September 2021 to March 2023, patients who were diagnosed with aortic aneurysm were included in whom endovascular exclusion of abdominal and thoracic aortic aneurysm was performed at the General Hospital of Mexico by the angiology vascular and endovascular surgery department. Results: 18 endovascular repairs of aortic aneurysms were performed, of which 15.4% were female (n=6) and 84.6% male (n=12). The average proximal neck diameter in the thoracic aorta was 31 mm, average proximal neck diameter in infrarenal AAA 22.2 mm, average aneurysmal diameter in infrarenal segment 63.8 mm, thoracic 31 mm. Regarding the type of endovascular procedure, 11.1% were repaired with the fenestrated endovascular aneurysm repair (FEVAR) technique, and the same proportion with chimney endovascular aneurysm repair (ChEVAR), for a resolution with conventional EVAR of 77.7%. Complications occurred in 3 patients, 2 of which resulted in type 1a and 1b endoleaks that were reoperated and repaired with a proximal cuff, balloon angioplasty, and embolization of the aneurysmal sac with coils. Conclusions: Aortic aneurysm remains a major cause of death in adults because of aortic rupture despite advances over the past two decades that have been made in the endovascular management of large, symptomatic, and ruptured. Timely treatment is essential to prevent rupture and poor patient outcomes.

Comparing Carotid Artery Stenting and Carotid Endarterectomy in Symptomatic and Asymptomatic Carotid Stenosis

Objective: In patients with symptomatic and asymptomatic carotid artery stenosis, this retrospective observational study compared the clinical outcomes and side effects of carotid endarterectomy (CEA) with carotid artery stenting (CAS). The study took patient-specific risk variables into account and concentrated on major adverse cardiovascular events (MACE), such as myocardial infarction (MI), stroke, readmission, and death. Material and Method: This was a retrospective observational study carried out at Vascular Surgery Department and Interventional Radiology department of two tertiary care hospitals in Rawalpindi, from Jan 2022 to March 2023. With a 30-day follow-up, 60 patients from two Pakistani tertiary care centres underwent either carotid end arterectomy and carotid artery stenting were included. Patient having asymptomatic and symptomatic carotid disease were selected for the procedure. The impact of risk factors on procedural success and development of major adverse cardiovascular events (MACE) was examined in the study. Data regarding 30-day postoperative parameters of the procedure were collected and evaluated. p&lt; 0.05 is considered significant. Results: The majority of patients in our series were males 46(77%) compared to 14(23%) females in the study. There were no intraoperative mortalities in our patients. The mortality rate of CAS alone was 1(1.66%). Four patients developed complications. Three in CAS group and 1 in CEA group. Comorbidities were present in 46(77%). Conclusion: Compared to CEA, CAS is linked to a greater risk of stroke or mortality in patients with symptomatic carotid stenosis within 30 days of treatment. Patients' unique characteristics, age, comorbidities, and previous surgical experiences should guide the choice of treatment.

Evaluating the correlation between WIFI score and outcome of intervention in infrainguinal artery in chronic limb threatening ischemia

Overview: The WIfI score was first introduced as an initial assessment, helping to predict the risk of limb amputation, the feasibility, and the benefit of revascularization in patients with chronic limb-threatening ischemia. Objectives: Determining the correlation between WIfI score and the outcome of endovascular intervention in the lower limb in chronic ischemia threatening limb stage. Methods: A retrospective study was conducted to identify the cases with chronic limb threatening ischemia of the infrainguinal artery occlusion, treated by endovascular intervention at the Department of Vascular Surgery, Cho Ray Hospital from August 2020 to May 2021. Results: There were 80 patients with 80 limbs that were treated, with mean age of 71.5, male gender accounted for 67.5%. Patients were admitted to the hospital with Rutherford stages 4,5,6 respectively 42.5%, 42.5% and 15%. WIfI stages 1,2,3,4 respectively 6.3%, 46.3%, 23.8%, 23.8%. The technical success rate was 96.3%, the wound healing rate was 79.1%, the primary patency rate was 64.9%, the limb salvage rate was 89.7%, the survival rate was 97.5%. The higher WIfI stage before intervention was associated with lower primary patency and limb salvage rates, statistically significant with p&lt;0.05. There was no correlation between WIfI stage and mortality rate. Conclusions: The WIfI classification system is very important in chronic limb-threatening ischemia, as it helps to estimate the limb salvage rate, predict the need for revascularization and wound healing.

Can Routine Investigation for Occult Pulmonary Embolism Be Justified in Patients with Deep Vein Thrombosis?

This study aims to investigate whether routine screening for silent pulmonary embolism (PE) can be justified in patients with deep vein thrombosis (DVT). We retrospectively analyzed the medical records of 201 patients with lower-extremity DVT admitted to the vascular surgery department of a single tertiary university center between 2019 and 2023. All patients underwent clinical evaluation, basic laboratory exams, a whole-leg colored duplex ultrasound, and a computed tomography pulmonary angiography (CTPA), to screen for an occult, underlying PE. The overall incidence of silent PE was 48.8%. The median admission D-dimer level was significantly higher in patients with silent PE than in those without PE (9.60 vs. 5.51 mg/L, P=0.001). A D-dimer value ≥5.14 mg/L was discriminant for predicting silent PE, with a sensitivity of 68.2% and a specificity of 59.3%. Silent PE was significantly more common on the right side, with the embolus located at the main pulmonary, lobar, segmental, and subsegmental arteries in 29.6%, 32.7%, 20.4%, and 17.3%, respectively. A higher incidence of occult PE was observed in patients with iliofemoral DVT (P=0.037), particularly when the thrombus extended to the inferior vena cava (P=0.003). Moreover, iliofemoral DVT was associated with a larger size and a more proximal location of the embolus (P=0.041). Multivariate logistic regression showed that male sex (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.39-3.53; P=0.026), cancer (OR=2.76, 95% CI: 1.45-4.07; P=0.017), previous venous thromboembolism (VTE) history (OR=2.67, 95% CI: 1.33-4.01; P=0.022), D-dimer value ≥5.14 mg/L (OR=2.24, 95% CI: 1.10-3.38; P=0.033), iliofemoral DVT (OR=2.13, 95% CI: 1.19-3.07; P=0.041), and thrombus extension to the IVC (OR=2.95, 95% CI: 1.43-4.47; P=0.009) served as independent predictors for silent PE. A high incidence of silent PE was observed in patients with lower-extremity DVT. Screening of patients with DVT who have the aforementioned predictive risk factors using CTPA for silent PE may be needed and justified for the efficient management of VTE and its long-term complications.

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation.

Currently, the bipolar radiofrequency ablation forceps manufactured by AtriCure are the main instrument for surgical ablation in patients with rheumatic heart disease (RHD) concomitant with atrial fibrillation (AF). The bipolar radiofrequency ablation forceps by Med-Zenith has a greater advantage in price compared with AtriCure. However, few studies have been reported on the comparison of their clinical efficacy. The aim of this study is to compare the short-term clinical efficacy of the two ablation forceps for RHD concomitant with AF. Clinical data of 167 patients with RHD concomitant with AF admitted to the Department of Cardiac Major Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, were retrospectively analyzed, and the restoration efficacy of sinus rhythm (SR) and cardiac function after surgery were compared with two ablation forceps. The end-systolic diameter of the right atrium and the end-systolic diameter of the left atrium in the patients of both groups at each postoperative time point decreased compared with that of the preoperative period (P < 0.05), and the left ventricular ejection fraction started to improve significantly at 6 months after surgery compared with that of the preoperative period (P < 0.05). There was no difference between the two groups of patients in the comparison of the aforementioned indicators at different points in time (P > 0.05). At 12 months postoperatively, the SR maintenance rate in using the ablation forceps by Med-Zenith (73.3%) was lower than that for AtriCure (86.4%) and the cumulative recurrence rate of AF in using the Med-Zenith ablation forceps was greater than that for AtriCure. The two bipolar radiofrequency ablation forceps compared in the study are safe and effective in treating patients of RHD concomitant with AF, and the ablation forceps by AtriCure may be more effective in restoring SR in the short term.

Results of Surgical Treatment of Patients with Symptomatic Abdominal Aortic Aneurysms

Relevance Abdominal aortic aneurysm is a common disease, manifested by an expansion of the abdominal aorta of more than 3 cm and accompanied by the development of serious complications with high mortality. There are symptomatic aneurysms, asymptomatic aneurysms and ruptured aneurysms. The timing of surgical intervention for symptomatic aneurysms still causes some controversy.Aim of study To determine the tactics and timing of surgery in patients with symptomatic abdominal aortic aneurysms.Material and methods The medical histories of 188 patients with symptomatic abdominal aortic aneurysms admitted to the Department of Vascular Surgery of N.V. Sklifosovsky Research Institute for Emergency Medicine. There were 152 men (80.8%) and 36 women (19.2%). The average age of those admitted was 69.8±2.5 years (from 53 to 84 years).Results All patients were divided into three groups, depending on the time of operation from the moment of admission: those operated in the first 24 hours (n=27); those operated from 24 to 72 hours from the moment of admission (n=20) and those operated later than 72 hours (n=136). The mortality by group was 14.8% in the first group, 20.0% in the second group, 7.3%in the third group.Conclusions Patients with symptomatic abdominal aortic aneurysm should be admitted to the intensive care unit for evaluation and preparation for delayed surgery. In cases where hospitalization in the intensive care unit is impossible or pain persists, the patient should be operated on urgently. When the pain syndrome is relieved and blood pressure is normalized, the patient can be further examined and operated on in a delayed manner.

Particularities of the course and treatment of non-ST elevation acute myocardial infarction: data from the REGION-IM registry

Aim. To characterize patients with acute non-ST elevation myocardial infarction (NSTEMI) hospitalized in Russian hospitals, study their anamnestic, demographic and clinical characteristics, treatment features and hospital outcomes, as well as compare data from previous Russian and foreign registries of acute coronary syndrome.Material and methods. Russian Registry of Acute Myocardial Infarction (REGION-IM) is a multicenter prospective observational study. The case report form contains demographic and anamnestic data, as well as the following information about the present MI: timing of symptom onset, first contact with medical personnel and admission to the hospital; data from coronary angiography (CAG) and percutaneous coronary intervention (PCI), therapy, hospitalization outcomes.Results. In total, for the period from November 1, 2020 to June 30, 2023, the study included 3253 patients with STEMI from 73 hospitals (30 vascular surgery departments, 17 of which are equipped with angiographic system, and 43 regional vascular surgery centers) from 45 constituent entities of the Russian Federation. There were 55% of high-risk patients. CAG was performed in 83,73% of patients. In 81%, CAG was performed ≤24 hours from hospitalization. PCI was performed in 62% of patients with NSTEMI. Median onset-to-balloon time was 27 hours [10;77]. The median door-to-balloon time was 5 hours [1;20]. Inhospital mortality was 3%. In the group with CAG, compared with the group without CAG, inhospital mortality was lower (2% and 6%, respectively; p&lt;0,05). In patients with a higher risk according to the GRACE, CRUSADE and ARC-HBR scales, CAG was performed less frequently.Conclusion. In patients with NSTEMI in Russian regions, there is a high frequency of CAG and PCI, including in the early stages. Inhospital mortality is low, especially in the invasive treatment group, and corresponds to data from international registries. In severely ill patients, revascularization is performed less frequently than in low-risk patients. There is room for increasing the prescription rate of modern effective anticoagulants and antiplatelet agents. In general, the quality of treatment for NSTEMI patients has improved in recent years.

Treatment of Aortoiliac Occlusive Lesions by Aortic Robotic Surgery: Learning Curve and Midterm Outcome

The learning curve and midterm results of aortoiliac occlusive disease (AIOD) revascularization by robot-assisted laparoscopic (RAL) surgery may be known. A prospective single-center study was conducted in the vascular surgery department of Georges Pompidou European Hospital (Paris, France). Patients with AIOD treated by RAL from February 2014 to February 2019 were included. Demographic characteristics, past medical history, Trans-Atlantic Inter-Society Consensus (TASC) lesions classifications, mortality, primary and secondary patency, as well as complication rates were collected. Safety was analyzed by the cumulative sum control chart method with a conversion rate of 10%, operative time by cumulative average-time model, and primary and secondary patency by the Kaplan-Meier method. Seventy patients were included, 18 (25.7%) with TASC C lesions and 52 (74.3%) with TASC D lesions. Before discharge, 14 (24.3%) patients had surgical complications. Among them, 10 (14.3%) required at least one reintervention. One (1.4%) patient died during the hospitalization. The learning curve in terms of safety (conversion rate) was 13 cases with an operating time of 220minutes after 35 patients. During follow-up (median 37months [21; 49]), 63 patients (91.3%) improved their symptoms, 53 (76.8%) became asymptomatic, and 3 graft limb occlusions occurred. The primary patency at 12, 24, 36, and 48months was 94%, 92%, 92%, and 92%, respectively, while the secondary patency for the same intervals was 100%, 98.1%, 98.1%, and 98.1%, respectively. Robotic surgery in AIOD revascularization seems safe and effective; allowing to treat patients with few comorbidities and severe lesions, in a dedicated center experienced in RAL, with excellent patency. Prospective clinical trials should be performed to confirm safety.

Endosutured Aneurysm Repair of Abdominal Aortic Aneurysms with Short Necks Achieves Acceptable Midterm Outcomes—Results from the Peru Registry

IntroductionThe study aims to describe midterm outcomes following treatment of infrarenal abdominal aortic aneurysms (AAAs) with short necks by endosutured aneurysm repair (ESAR) using the Heli-FX EndoAnchor system. MethodsThis is a retrospective study of prospectively collected data from nine vascular surgery departments between June 2010 - December 2019, including treated AAAs with neck lengths ≤ 10mm. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each centre’s practice. There were two subgroups further assessed according to neck length, A (≥4 and < 7mm) and B (≥7 and ≤10mm). The main outcomes analysed were technical success, freedom from type Ia endoleaks (TIaEL), sac size increase, all-cause (ACM) and aneurysm related mortality (ARM). Results76 patients were included in the study, 17 fell into Subgroup A and 59 into subgroup B. Median follow-up for the cohort was 40.5 (IQR 12-61) months. A median of 6 (IQR 3) EndoAnchors were deployed in each subject. Technical success was 86.8% for the total group, 82.4% and 88.1% (p=0.534) for subgroups A and B respectively. Six out of ten (60%) of TIaELs at the completion angiographies showed spontaneous resolution. Cumulative freedom from TIaEL at 3 and 5 years for the total group was 89% and 84% respectively; this was 93% and 74% for subgroup A and 88% at both intervals in subgroup B (p=0.545). In total, there were 7 (9.2%) patients presenting with type Ia endoleaks over the entire study period. Two (11.8%) in subgroup A and 5 (8.5%) in subgroup B (p=0.679). There were more patients with sac regression in subgroup B (subgroup A=6 - 35.3% versus subgroup B=34 - 57.6%, p=0.230) with no statistical significance. ACM was 19 (25%) patients, with no difference (4 – 23.5% versus 15 – 25.4%, p=0.874) between subgroups; whereas ARM occurred in one patient from subgroup A and 3 from subgroup B. ConclusionsThis study demonstrates reasonable outcomes for patients with short-necked AAAs treated by ESAR in terms of type Ia endoleaks up to 5 year follow up. EndoAnchor use should be judiciously evaluated in short necks and may be a reasonable option when anatomical constraints are encountered, mainly for those with 7-10mm neck lengths. Shorter neck length aspects, as indicated by the results from Group A, may be an alternative when no other options are available or feasible.

Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients.

(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: "functional AVF" for those with a permeable AVF and "AVF failure" for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan-Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations.

AUTOTRANSPLANTATION WITH EXTRACORPORAL RECONSTRUCTION OF RENAL VESSELS: A CLINICAL CASE OF “THE NUTCRACKER SYNDROME” AND LEFT RENAL ARTERIES HYPOPLASIA COMBINATION

Ex vivo kidney autotransplantation with renal artery reconstruction is an effective method of surgical correction of vascular abnormalities (fibromuscular dysplasia, hypoplasia, and renal artery aneurysms) showing good long-term results. The combination of renal artery abnormalities with aorto-mesenteric compression syndrome (“the nutcracker” syndrome) is extremely rare and complicates the diagnosis making greatly. Renal artery hypoplasia is an abnormality that is rarely diagnosed and may not manifest clinically in the absence of contralateral kidney pathology as well as its vascular structures. Renal hypoplasia may be caused by mutations in the kidney development genes (HNF1B, PAX2, PBX1) and/or several environmental factors such as intrauterine growth retardation, maternal diseases (diabetes, hypertension), medication taken by the mother (renin-angiotensin system inhibitors or nonsteroidal anti-inflammatory drugs) and intoxication (smoking and alcohol). Premature delivery (before the 36th week) is also a risk factor due to incomplete nephrogenesis. Renal arteries hypoplasia is associated with fibromuscular dysplasia in most cases. The disease is characterized by non-inflammatory non-uniform focal hyperplasia of the renal artery wall with damage to small and medium arteries. Simultaneous damage to two or more vascular segments is detected in 25% of patients.&#x0D; A clinical case of successful treatment of “the nutcracker” syndrome (annular renal vein) combined with hypoplasia of the left main and accessory renal arteries associated with fibromuscular dysplasia is described. A 27-year-old female was admitted to the Department of Vascular Surgery of Municipal Noncommercial Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” on October 4, 2021, with complaints of pain in the left lumbar region and the left half of the abdomen, hematuria, proteinuria, a persistent increase in blood pressure. Ultrasound of the renal veins: the left renal vein in the aorto-mesenteric segment was not visualized, the posterior portion of the left renal vein was determined. Peak systolic velocity was up to 230 cm/s at the point of confluence with the inferior vena cava and 28 cm/s more distally. The vein was up to 12.0 mm in the renal hilum and up to 11.0 mm in the middle third. MSCT of the abdominal cavity, retroperitoneal space and pelvic organs: CT signs of pyelonephritis of the left kidney. Hypoplasia of the left kidney. Reactive para-aortic lymphadenopathy on the left. Hypoplastic left renal artery (3,8 mm) and presense of accessory ones, annular left renal vein. Angiomyolipoma of the right kidney (2,6 cm). Varicose veins of the small pelvis on the left. The patient underwent surgical treatment, namely ex vivo autovenous prosthetic repair of the left renal artery with autotransplantation of the left kidney. The course of the postoperative period was without complications, the reconstruction was functioning. Ultrasound of the renal vessels (1 week after the surgery): the blood flow was located in the renal hilum in the course of Doppler sonography of intrarenal branches. Venous outflow was unobstructed. Corticomedullary differentiation was marked satisfactorily.&#x0D; The study presented by us demonstrates the effectiveness of kidney autotransplantation for the correction of renal vascular abnormalities.&#x0D; Though of a solitary nature, the combination of renal vessels abnormalities complicates significantly the course of the disease and the possibilities of this pathology diagnostics.