6 research outputs found
The combination of vacuum-assisted thromboaspiration and covered stent graft for acute limb ischemia due to thromboembolic complications of popliteal aneurysm
No full textBackground: We present a standardized protocol of endovascular revascularization for patients with acute limb ischemia due to popliteal artery aneurysm (PAA) thromboembolic complication, based on the combination of vacuum-assisted thromboaspiration to improve tibiopedal outflow and covered stent graft to exclude the PAA.Methods: All patients with a diagnosis of PAA complicated by thromboembolic events undergoing total endovascular rescue were prospectively enrolled in a dedicated database from November 2018 to November 2021. To assess vessel patency, the TIPI (Thromboaspiration In Peripheral Ischemia) classification was used. The primary end point was the primary technical success (at least one tibial vessel with a TIPI flow of 2 or 3). The 30-day overall mortality and amputation rates were considered as secondary end points. Patients' overall survival, limb salvage, freedom from reocclusion and reinterventions were reported as secondary late outcomes using Kaplan-Meier method.Results: Seventeen male patients were enrolled with a mean age of 75.7 +/- 9 years. Rutherford grading score was IIa in 52.9% (9/17) and IIb in 47.1% (8/17). PAA mean diameter was 37.4 +/- 11.2 mm. All patients had tibial arteries involvement, and in 9 cases (52.9%) there was also the occlusion of the PAA. Mechanical thrombectomy with Indigo/Penumbra thromboaspiration system was used in all patients. PAAs were excluded using one or more VIABAHN covered endografts (range 1-3 pieces). Technical success was achieved in 94.1%. Fasciotomy was performed in 1 case (5.9%). Mortality and amputation rates at 30-day follow-up were respectively 0% and 5.9%. Survival rates at 6, 12, and 24 months were respectively 94.1%, 86.3%, and 67.9%. Secondary patency was achieved in all cases (100%). Freedom from reintervention was 80.4%, 65.8%, and 54.8% at 6-, 12-, and 24-month follow-up. Limb salvage was 88.2% at 6-, 12-, and 24-month follow-up, respectively.Conclusions: Although preliminary, our experience of total endovascular rescue for complicated PAA with thromboembolic events highlighted promising rates of limb salvage at 30 days after intervention. The total endovascular approach seems able to maximize tibiopedal outflow offering an interesting strategy in limb salvage
Residual Aneurysmal Sac Shrinkage Post-Endovascular Aneurysm Repair: The Role of Preoperative Inflammatory Markers
No full textIntroduction: In this study, we evaluated the role of preoperative inflammatory markers as Neutrophil-to-Lymphocyte (NLR) and Platelet-to-Lymphocyte (PLR) ratios in relation to post-endovascular aneurysm repair (EVAR) sac shrinkage, which is known to be an important factor for abdominal aortic aneurysm (AAA) healing. Methods: This was a single-center retrospective observational study. All patients who underwent the EVAR procedure from January 2017 to December 2020 were eligible for this study. Pre-operative blood samples of all patients admitted were used to calculate NLR and PLR. Sac shrinkage was defined as a decrease of ≥5 mm in the maximal sac diameter. The optimal NLR and PLR cut-offs for aneurysmal sac shrinkage were obtained from ROC curves. Stepwise multivariate analysis was performed in order to identify independent risk and protective factors for the absence of AAA shrinkage. Kaplan–Meier curves were used to evaluate survival rates with respect to the AAA shrinkage. Results: A total of 184 patients were finally enrolled. The mean age was 75.8 ± 8.3 years, and 85.9% were male (158/184). At a mean follow-up of 43 ± 18 months, sac shrinkage was registered in 107 patients (58.1%). No-shrinking AAA patients were more likely to be older, to have a higher level of NLR and PLR, and be an active smoker. Kaplan–Meier curves highlighted a higher rate of survival for shrinking AAA patients with respect to their counterparts (p < 0.03). Multivariate analysis outlined active smoking and NLR as independent risk factors for no-shrinking AAA. Conclusions: Inflammation emerged as a possible causative factor for no-shrinking AAA, playing a role in aneurysmal sac remodeling. This study revealed that inflammatory biomarkers, such as NLR and PLR, can be used as a preoperative index of AAA sac behavior after EVAR procedures
Elective surgical repair of popliteal artery aneurysms with posterior approach vs. endovascular exclusion: early and long term outcomes of multicentre PARADE study
No full textObjective: The aim of this study was compare elective surgical repair of popliteal artery aneurysms (PAAs) via a posterior approach vs. endovascular exclusion, analysing early and five year outcomes in a multicentre retrospective study. Methods: Between January 2010 and December 2023, a retrospectively maintained dataset of all consecutive asymptomatic PAAs that underwent open repair with posterior approach or endovascular repair in 37 centres was investigated. An aneurysm length of ≤ 60 mm was considered the only inclusion criterion. A total of 605 patients were included; 440 PAAs (72.7%) were treated via a posterior approach (open group) and the remaining 165 PAAs (27.3%) were treated using covered stents (endo group). Continuous data were expressed as median with interquartile range. Thirty day outcomes were assessed and compared. At follow up, primary outcomes were freedom from re-intervention, secondary patency, and amputation free survival. Secondary outcomes were survival and primary patency. Estimated five year outcomes were compared using log rank test. Results: At 30 days, no differences were found in major morbidity, mortality, graft occlusion, or re-interventions. Three patients (0.7%) in the open group experienced nerve injury. The overall median duration of follow up was 32.1 months. At five year follow up, freedom from re-intervention was higher in the open group (82.2% vs. 68.4%; p = .021). No differences were observed in secondary patency (open group 90.7% vs. endo group 85.2%; p = .25) or amputation free survival (open group 99.0% vs. endo group 98.4%; p = .73). A posterior approach was associated with better survival outcomes (84.4% vs. 79.4%; p = .050), and primary patency (79.8% vs. 63.8%; p = .012). Conclusion: Early and long term outcomes following elective repair of PAAs measuring ≤ 60 mm via a posterior approach or endovascular exclusion seem comparable. Nerve injury might be a rare but potential complication for those undergoing open surgery. Endovascular repair is associated with more re-interventions
Great saphenous vein versus expanded polytetrafluoroethylene graft in patients undergoing elective treatment of popliteal artery aneurysm with a posterior approach
No full textBackground: The aim of this study was to compare 30-day and 5-year outcomes of great saphenous vein (GSV) vs expanded polytetrafluoroethylene (ePTFE) graft in patients undergoing elective treatment of popliteal artery aneurysm (PAA) using a posterior approach. Methods: Between January 2010 and December 2023, a retrospectively maintained dataset of all consecutive asymptomatic PAAs who underwent open repair with posterior approach or endovascular repair in 40 centers was investigated. Of 971 cases, 525 patients were included in the present analysis. These were further divided into posterior approach with GSV graft (252; GSV group), and posterior approach with ePTFE graft (273; ePTFE group). Thirty-day outcomes were assessed and compared. During follow-up, survival, primary patency, secondary patency, freedom from reintervention(s), and amputation-free survival rates were compared between the two groups using log-rank tests. Univariate and multivariate Cox regression analyses were performed in the ePTFE group to find predictive factors of poor outcomes. Results: Two groups were homogeneous in terms of preoperative risk factors and morphological data. Median follow-up duration was similar (24 months [interquartile range [IQR], 10-36 months] GSV group vs 21 months [IQR, 7-47 months] ePTFE group; P =.123). At 5 years, there were no differences between the two groups in terms of survival (84.7% GSV group vs 86.1% ePTFE group; P =.097, log-rank = 2.756), secondary patency (94.9% GSV group vs 89.4% ePTFE group; P =.068, log-rank = 3.336), or amputation-free survival (99.1% GSV group vs 99.6% ePTFE group; P =.567, log-rank =.328). Five-year primary patency (89.5% GSV group vs 76.2% ePTFE group; P =.007, log-rank = 7.239) and freedom from reintervention(s) (92.8% GSV group vs 80.6% ePTFE group; P =.011, log-rank = 6.449) were significantly higher in the GSV group. Using multivariate analysis in the ePTFE group, factors compromising primary patency were patients on dialysis (P =.054; odds ratio, 3.641), and patients who were not on any preoperative antiplatelet therapy or anticoagulation (P =.019; odds ratio, 5.532), whereas none of the perioperative factors affected freedom from reintervention(s). Conclusions: GSV as graft guaranteed better primary patency with lower reinterventions rates at midterm follow-up after treatment of PAAs via a posterior approach. Patients on dialysis and who were not on any preoperative antiplatelet therapy or anticoagulation had lower patency rates
Late outcomes of Viabahn self-expandable covered stent for the elective treatment of popliteal artery aneurysms
No full textObjective: In the present study we aim to evaluate in detail the late outcomes of the overall endovascular cohort of the PARADE study, with a focus on factors that could influence such outcomes as these may provide useful insights for patients and clinicians alike. Methods: Between January 2010 and December 2023 patients with non-acute elective PAAs undergoing endovascular exclusion with the Viabahn stent-graft were included in a multicenter retrospective cohort study (40 sites from 10 countries). A cut-off of 15 procedures was used to define a participating center as "high-volume" (>15) or "low-volume" (<15). Results: During the 14-year studied period, 326 patients were treated who met inclusion criteria for the present study. Patients were predominantly male (304, 93.3%) with a mean age of 74.6 ± 9.2 years. Most of patients were asymptomatic (221, 67.8%), whilst 56 (17.2%) had intermittent claudication, and 49 (15%) CLTI. Acute technical success was not obtained in 2 cases (0.6%), due to residual type Ia endoleak (1 case), and residual type Ib endoleak (1 case), Of these, one patient received an open conversion, whereas the other one was followed up because unfit for any type of reintervention. At 30 days, 2 patients died with an overall 30-day mortality rate of 0.6%. Both were not cardiovascular deaths related to interventions. In addition, 30-day rates of MACE, graft occlusion, and procedure-related reinterventions were 1.2%, 3.7%, and 5.2%, respectively. No patient underwent early major amputation. The 5-year Kaplan-Meier estimates of primary patency, secondary patency, freedom from reinterventions(s), and amputation-free survival were 65.8% (95% CI: 61.7% to 71.9%), 84.9% (95% CI: 78.7% to 89.1%), 70.5% (95% CI: 66.2% to 74.8%), and 98.2% (95% CI: 96.4% to 99.6%), respectively. Amputation-free survival was adversely affected by active smoking (p = .011), chronic kidney disease (p < .001), poor run-off status (p = .042), and low number of cases for each center (<15) (p = .011). Multivariate analysis reported an approaching significance for active smoking (HR 3.460, 95% CI 2.6 to 6.1, p = .051), and confirmed the association with chronic kidney disease (HR 7.413, 95% CI 5.4 to 9.3, p = .006). Conclusion: The findings from this study show that endovascular repair using the Viabahn stent-graft may provide a feasible technical option for elective treatment of PAA. Some patient-related and procedure-related factors were identified, including chronic kidney disease, that were associated with higher rates of long-term complications
