Endovascular Surgical Interventions Research Articles

ULTRASONIC CRITERIA FOR ASSESSING TREATMENT OUTCOMES IN PATIENTS WITH ISCHEMIC FORM OF DIABETIC FOOT SYNDROME WHO UNDERWENT ENDOVASCULAR RESTORATIVE SURGICAL OPERATIONS

The article highlights the effectiveness of ultrasound monitoring of outcomes of the endovascular restorative surgical interventions in patients with the ischemic form of diabetic foot syndrome, which resulted from occlusive-stenotic lesions of the popliteal-tibial segments. The purpose of the study was to investigate the findings of ultrasound monitoring following the endovascular treatment with various methods of occlusive-stenotic lesions of the popliteal and tibial arteries in patients with the ischemic form of diabetic foot syndrome and to assess the effectiveness of the treatment. The study included 112 patients, who received the inpatient treatment for the complicated ischemic form of diabetic foot syndrome at the Department of Vascular Surgery, Poltava Regional Clinical Hospital, for 2017-2021. The ultrasound and angiographic examination revealed significant hemodynamical occlusive-stenotic lesions of the popliteal and tibial arteries. These patients were indicated to have restorative endovascular surgical interventions. Depending on the methods of the interventions, patients were divided into two study groups. The first group included 58 (51.8%) patients, who underwent balloon angioplasty of the tibial arteries according to general standard techniques. The second group included 54 (48.2%) patients, who underwent staged dosed balloon angioplasty of the tibial arteries according to the technique we elaborated by ourselves. When analyzing the findings obtained by colour ultrasound scanning of the arteries of the lower extremities before performing endovascular operations and on the 2nd and 7th day of the postoperative period, we have found out that the blood flow has improved significantly that is confirmed by a reliable acceleration of the peak blood flow rate and the humeral index. This is quite pronounced in the patients of the second group, who underwent step-by-step dosed balloon angioplasty of the tibial arteries. The positive changes are supported by the occurrence of fewer thromboses in the operated sections of the arteries in the early postoperative period in the patients of the second group compared to patients in the first group.

Study of the changed level of angiogenesis activation factors after endovascular treatment of arteriovenous malformations depending on the type of embolizing material and the radicality of exclusion of the malformation from the blood flow

Objective ‒ тo study changes in angiogenesis factors (VEGF-A, VEGFR-1, Great Endothelin-1) in the blood plasma of patients with arteriovenous malformation (AVM) of different localization before and after endovascular treatment depending on the type of embolizing material used and the results of AVM exclusion from the bloodstream.Materials and methods. The results of treatment in 2019–2022 were analyzed in 27 patients (11 (41.0 %) men and 16 (59.0 %) women) with AVMs of different localization who underwent endovascular treatment. The age of the patients ranged from 11 to 47 years, the average age was (32.8 ± 5.1) years. Patients with AVM were divided into two groups depending on the type of embolizing material: liquid substances (n=12) and emboli and coils (n=15). The control group was formed from 25 healthy people (10 men and 15 women) without AVM, in which the concentration of VEGF-A, VEGFR-1, Great Endothelin-1 in the blood plasma was determined for 3 months. The average age of the control group was (37.4 ± 4.8) years (from 16 to 57 years).Results. It was proved that the concentration of VEGF-A in blood plasma in patients with AVM before endovascular treatment was statistically significantly higher by 4.5 times than in the control group, VEGFR-1 by 3.0 times, Great Endothelin-1 by 2.12 times. Within 5‒7 days after embolization, a sharp increase in the level of angiogenesis induction factors was noted by 2.5–3.0 times compared to the initial indicator and a slow decrease during 3 months. However, with the use of liquid embolizing substances, no increase in VEGFR-1 concentration was registered. A comparison of the level of angiogenesis factors before and after endovascular surgical interventions revealed that the total exclusion of AVMs from the bloodstream contributes to the reduction or normalization of the content of angiogenesis factors, while the partial exclusion of AVMs from the bloodstream leads to an increase in their level due to the preservation of the source of production in the AVM structure.Conclusions. It was established that AVMs remain physiologically active during the life of the organism and undergo vascular remodeling as a result of constant pathological neoangiogenesis. Factors of angiogenesis actively respond to endovascular interventions by changing the expression of VEGF-A, VEGFR-1 and Great Endothelin-1 in the blood plasma, depending on the type of embolizing material and the radicality of AVM exclusion from the bloodstream. This is one of the main reasons for remission or further growth of AVMs and recurrences.

Adjunct procedures for malperfusion syndrome in complicated acute type B aortic dissection

: Acute aortic dissection is a common and often fatal aortic emergency. Treatment of type Baortic dissection typically consists of medical therapy in the uncomplicated cases, with surgical therapy reserved for complicated aortic dissection. Surgical therapy has shifted from traditional open surgical intervention to less invasive endovascular surgical interventions as a first line option. Complicated aortic dissection often presents as visceral or lower limb malperfusion (LLM). Conventional therapy of complicated aortic dissection has been revascularization of the affected vascular bed. Recently, numerous clinical trials and retrospective series have shown that treatment of the proximal aortic entry tear combined with targeted revascularization of the ischemic vascular bed leads to improved short term and long-term patient outcomes. This article outlines the interventional approach to the patient with complicated aortic dissection.

Comparative assessment of the frequency and risk factors of purulent-septic infections in adult patients after various types of open and closed heart surgery

BACKGROUND: The widespread increase in the number and types of cardiac surgery necessitate the study of frequency and risk factors of postoperative purulent-septic infections (PSIs).
 AIM: to provide a comparative assessment of the PSI frequency and risk factors in adult patients after various types of cardiac surgery.
 MATERIALS AND METHODS: Based on the cardiac surgery hospital materials, medical records of 4.815 patients over 18 years of age, who underwent open (n = 1.540) and closed (n = 3.275) heart surgeries within 1 year, were analyzed. The typical and prenosological forms of PSIs were taken into account in accordance with the epidemiological standard of case definition.
 RESULTS: The incidence rates for typical and prenosological PSI forms amounted to 39.6 and 72.7 per 1000 surgeries after open heart surgery, respectively, and 3.1 and 3.9 after minimally invasive endovascular surgical interventions, respectively. The main clinical forms of PSI after open and closed heart surgeries were surgical site infections, nosocomial pneumonia, urinary tract infection, and bloodstream infection. In an open heart surgery, the maximum incidence rates for typical and prenosological forms of PSIs were recorded after surgeries on the aorta and less often after heart valve replacement or coronary artery bypass grafting. The increased incidence rate after aortic surgery was mainly due to urinary tract infection and nosocomial pneumonia. In the case of closed heart surgery, no statistically significant differences were detected between the incidence rates of PSIs after coronary artery stenting, cardiac arrhythmia and carotid artery stenosis surgery, and other interventions. The duration of both the surgery itself and the subsequent patient stay in the intensive care unit was found to be important as risk factors for PSIs after cardiac surgery.
 CONCLUSION: The incidence rate of PSIs after open heart surgery is significantly higher than after closed heart surgery, which is mostly associated with the duration of surgical intervention and the subsequent patient stay in the intensive care unit.

Intervention in Takayasu Aortitis: When, Where and How?

Takayasu arteritis is a large vessel vasculitis which commonly affects the aorta and its major branches. Active arterial inflammation is characterised by the presence of T and B lymphocytes, natural killer cells, macrophages and occasional multinucleate giant cells. Uncontrolled vascular inflammation can progress to cause arterial stenosis, occlusion or aneurysmal dilatation. Medical treatment involves combination immunosuppression and more recently biologic therapies targeting TNF-α and IL-6. Due to the typical delays in diagnosis and accumulation of arterial injury, open and endovascular surgical intervention are important and potentially life-saving treatment options for Takayasu arteritis. Common indications for surgery include aortic coarctation and ascending aortic dilatation ± aortic valve regurgitation, renal artery stenosis, ischaemic heart disease, supra-aortic disease, mesenteric ischaemia, severe limb-threatening claudication and aneurysm repair. Surgical outcomes are markedly improved in patients with clinically inactive disease and those who receive adequate periprocedural immunosuppression. Decisions regarding surgical approaches are best made as part of a multi-disciplinary team.

FEATURES OF EMERGENCY SURGERY IN PATIENTS WITH LOCALLY ADVANCED GASTRIC CANCER

Summary. Materials and methods. The work is based on an analysis of the results of surgical treatment of 418 patients with complicated locally advanced gastric cancer. Patients are divided into two groups: comparisons — 212, and the main — 206 patients who were treated from 2006 to 2010. and from 2011 to 2015 respectively. The complications rating was: bleeding in 252 (60.3 %) patients, stenosis in 89 (21.3 %), perforation in 15 (3.5 %), and their combination in 62 (14.8 %).
 Results and discussion. Radical operations were performed in 212 (50.7 %) patients, in 145 (34.6 %) — palliative and symptomatic. Postoperative complications occurred in 82 patients (19.6 %), postoperative mortality was 7.2 % (30 patients). A two-stage surgical tactics has been developed, which involves the implementation of minimally invasive endoscopic and endovascular surgical interventions at the first stage with the implementation of a delayed or planned surgical intervention at the second stage.
 Conclusions. Urgent operations decreased from 21.7 to 6.3 %, which reduced the number of palliative and symptomatic operations from 50.4 to 18.4 %.

ТHE PLACE OF ENDOVASCULAR SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

Summary. The purpose of the study. To determine the possibility of endovascular surgical interventions and their effectiveness in patients with critical ischemia of the limbs.
 Materials and methods. The object of research was 209 patients with critical ischemia of the limbs, ages 53 to 71 years, which made endovascular surgical interventions.
 The results. Analysis of results of endovascular surgery witness that balloon angìoplasty with stenting zone for reconstruction and balloon angìoplasty with paclitaxel give the smallest percentage of reocclusion and restenosis in the early and late postoperative period than balloon angìoplasty.
 Conclusions. 1. The use of endovascular surgical interventions is a promising method of treatment of critical ischemia of the lower extremities, especially in the elderly and senile. 2. In case of critical ischemia of the limbs should be used balloon angìoplasty with stenting or balloon angìoplasty with paclitaxel, based on the results of early and late postoperative period.

Perioperative administration of micronized purified flavonoid fraction in endovascular treatment of varicose disease

The study was aimed at assessing efficacy and safety of using a micronized purified flavonoid fraction in the perioperative period in patients scheduled for endovascular surgical intervention for CEAP clinical class C2 lower limb varicose veins. This study enrolled a total of 1519 patients with CEAP C2a,sEpAs (primary varicose vein with valvular incompetence of the great and/or small saphenous vein) who were subdivided into two groups. Group One included 1039 patients who in the perioperative period were prescribed a micronized purified flavonoid fraction at a daily dose of 1000 mg and who continued therapy, including visit 4. Group Two was composed of 480 patients taking no venoactive agents. The main criterion for assessing efficacy of the micronized purified flavonoid fraction was the incidence rate of typical adverse events in the compared groups of patients after surgical intervention. The patients receiving the micronized purified flavonoid fraction were found to have adverse events significantly less often as compared with those in the control group: ecchymosis 7.1 versus 11.0% (p=0.01), haematoma 0.5 vs 1.3% (p=0.1), paresthesia 0.5 vs 1.7% (p=0.02), thrombophlebitis 0.2 vs 0.6% (p=0.2), pigmentation 0.6 vs 3.3% (p=0.001), heat-induced thrombosis 0.3 vs 1.3% (p=0.02). The total incidence rate of adverse events in patients receiving and those not receiving the micronized purified flavonoid fraction amounted to 7.6 vs 15.0%, respectively (<0.001). The micronized purified flavonoid fraction prescribed in the perioperative period, owing to a pluripotent mechanism, adapts the venous system and microcirculatory bed of the lower extremities to operative stress, decreasing the anti-inflammatory response to endovascular intervention, lowering thereby the incidence of undesirable events. Prescription of the micronized purified flavonoid fraction in the perioperative period ensures a significant decrease in the incidence of typical adverse events developing after endovascular surgical treatment for CEAP clinical class C2 varicose veins and may be recommended for real clinical practice.

Abstract 129: Parthenolide Inhibits Inflammatory Dysfunction of Human Aortic Endothelial Cells and Proliferation of Smooth Muscle Cells in vitro and Restenosis in a Rat Model

Background: Cardiovascular diseases remain the leading cause of death in developed countries. Endovascular surgical interventions trigger uncontrolled proliferation of smooth muscle cells (SMCs) in the intima (intimal hyperplasia) leading to lumen re-narrowing (restenosis). Despite extensive efforts devoted to therapeutic methods with a focus on inhibiting SMC proliferation, restenosis persists at a significant rate. In recent years, a growing body of knowledge has underscored a crucial role for endothelium damage in the pathophysiology of restenosis, suggesting that preservation of the endothelium would provide an effective approach for effectively curbing restenosis. Methods and Results: We utilized high-throughput screening methods to search for small molecules that could inhibit the proliferation of human aortic SMCs without damaging human aortic endothelial cells (ECs). We identified such a lead compound in Prestwick Library; i.e. Parthenolide, a sesquiterpene lactone extracted from feverfew. Treatment with a low dose (1 μM) of Parthenolide for 96h inhibited SMC but not EC proliferation. When the cells were stimulated with inflammatory cytokines (TNF-α or IL-1β), Parthenolide mitigated cytokine-induced proliferation and MCP-1 production of SMCs, but rescued cytokine-induced endothelial dysfunction, including apoptosis, proliferation, decrease of eNOS, and increase of inflammatory markers. Mechanistic studies showed that while Parthenolide treatment in both SMCs and ECs induced NRF-2 activation (nuclear translocation), NRF-2 knockdown with siRNA diminished the aforementioned beneficial effects of Parthenolide in both cell types. In contrast, NFkB activation was not significantly affected by Parthenolide. In a rat balloon angioplasty model, perivascular delivery of Parthenolide in Pluronic gel effectively inhibited intimal hyperplasia and restenosis 14 days after surgery. Conclusion: These results indicate that the natural compound Parthenolide differentially attenuates pathological behaviors of both human vascular SMCs and ECs, whereas known agents as such are scarce. Thus Parthenolide may serve as a promising lead compound for future development of next-generation anti-restenotic therapeutics.

Ambulance smartphone tool for field triage of ruptured aortic aneurysms (FILTR): study protocol for a prospective observational validation of diagnostic accuracy

IntroductionRupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible...

Inhibition of intimal hyperplasia from epigallocatechin-3-O-gallate released by exovascular treatment of electrospun poly(L-lactide glycolic acid) fiber sheets containing epigallocatechin-3-O-gallate in injured abdominal aorta

Inhibition of intimal hyperplasia from epigallocatechin-3-O-gallate released by exovascular treatment of electrospun poly(L-lactide glycolic acid) fiber sheets containing epigallocatechin-3-O-gallate in injured abdominal aorta

SAT0294 Longitudinal Analysis Suggests Clinical Outcomes in Takayasu Arteritis Are Improved by Early Combination Immunosuppression with Serial Non-Invasive Imaging

BackgroundTakayasu arteritis (TA), a granulomatous large vessel vasculitis affecting young patients, pre-disposes to stenoses and aneurysmal dilatation of the aorta and its branches. Despite morbidity remaining high, evidence for the...

Systematic review and meta-analysis of surgical interventions versus conservative therapy for venous ulcers

This goal of this study was to systematically review the literature to determine if surgical intervention (open or endovascular) is superior to compression alone with respect to ulcer healing, ulcer recurrence, and time to ulcer healing in patients with lower extremity venous ulcer disease. We conducted a comprehensive search of multiple databases for randomized controlled trials (RCTs) and comparative observational studies from 1990 to December 2013. The interventions of interest were any open or endovascular surgical interventions on the venous system in the lower extremity compared with compression alone. We included 11 studies (seven RCTs and four observational studies) with moderate to increased risk of bias. The meta-analysis of all studies demonstrated increased healing rate (pooled risk ratio [RR], 1.06; 95% confidence interval [CI], 1.00-1.13; I(2) = 10%) and lower risk of recurrence (RR, 0.54; 95% CI, 0.34-0.85; I(2) = 27%) with open surgical procedures compared with compression. However, the meta-analysis of only RCTs showed no difference, possibly due to imprecision. The meta-analysis of three RCTs showed no difference in time to ulcer healing, -0.41 (95% CI, -0.89 to 0.07). Two studies of endovascular surgical procedures compared with compression showed no significant difference in ulcer healing (RR, 1.65; 95% CI, 0.43-6.32). One study of open surgical venous ligation and stripping compared with endovenous laser also showed no significant difference in ulcer recurrence (RR, 0.83; 95% CI, 0.21-3.27). Open surgical interventions may improve lower extremity venous ulcer healing. The quality of this evidence is low because the analysis was dominated by the results of observational studies. The current evidence does not definitively support the superiority of endovascular surgical interventions compared with compression alone.

Endovascular treatment for cervical carotid artery stenosis presenting with progressing stroke: three case reports

BACKGROUND Progressing stroke is said to occur when symptoms and signs worsen in cases of ischemic stroke. Although conservative methods using volume expansion with antithrombotic or anticoagulative agents are widely used for progressing stroke, in some hospitals, emergency carotid endarterectomy (CEA) has been performed for carotid stenosis, with mixed results. Here we report three cases with progressing ischemic stroke that were managed by endovascular surgical intervention. CASE DESCRIPTION We performed endovascular surgery in three patients with cervical carotid artery stenosis presenting with progressing stroke or crescendo transient ischemic attacks. Endovascular treatment was less invasive and feasible for acute phase treatment. While local thrombolysis alone was found to be less effective, stent placement induced complete resolution of stenosis, but may result in hyperperfusion syndrome or hemorrhagic infarction. CONCLUSIONS In an emergency, percutaneous transluminal angioplasty with proper dilatation is preferred, and then CEA or stenting should be considered after the patient’s condition stabilizes.