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Influence of severe neck angulation on hemodynamic and clinical outcomes following endovascular aneurysm repair:a hemodynamic analysis and a retrospective cohort study

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Chinese Medical Journal 2022年第21期135卷 2577-2584页

作者： Yang Liu Ming Qing Jichun Zhao Bin Huang Yi Yang Tinghui Zheng Ding Yuan Department of Vascular Surgery West China HospitalSichuan UniversityChengduSichuan 610041China Department of Applied Mechanics Sichuan UniversityChengduSichuan 610065China

Background: For patients with severe neck angulation (SNA), hemodynamic and clinical outcomes following endovascular aneurysm repair (EVAR) are still unclear. This study aimed to explore the influence of SNA on hemodynamic and clinical outcomes following EVAR.Methods: This study included a hemodynamic analysis and a retrospective cohort study from West China Hospital of Sichuan University between January 2011 and December 2020. The Cox regression model, inverse probability of treatment weighting (IPTW) analysis, sensitivity analysis, and subgroup analysis were applied. Primary outcome was type IA endoleak (T1AEL).Results: In this hemodynamic analysis, nine non-severe neck angulation (nSNA) and 16 SNA idealized models were constructed. We found a significant difference in drag force between SNA and nSNA models (7.016 ± 2.579 Nvs. 4.283 ± 1.460 N,P = 0.008), and proximal neck angles were significantly associated with the magnitude of drag force (F = 0.082 ×α-0.006 ×β + 2.818, α: 95% confidence interval [CI] 0.070-0.094;P = 0.001;β: 95% CI -0.019 to 0.007;P = 0.319). In our cohort study, 514 nSNA patients (71.5 ± 8.5 years;459 males) and 208 SNA patients (72.5 ± 7.8 years;135 males) were included, with a median follow-up duration of 34 months (16-63 months). All baseline characteristics were well balanced after IPTW matching. We found that SNA was associated with a significant risk of adverse limb event (hazard ratio [HR] 2.18, 95% CI 1.09-3.12), yet was not associated with T1AEL, overall survival, or reintervention. In patients without proximal or distal additional procedures (DAP), subgroup analyses suggested a significant risk of T1AEL (Proximal: HR 5.25, 95% CI 1.51-18.23;Distal: HR 5.07, 95% CI 1.60-16.07) and adverse limb event (Proximal: HR 2.27, 95% CI 1.01-5.07;Distal: HR 2.91, 95% CI 1.30-6.54) in SNA patients. However, no noticeable difference was observed in patients with proximal or DAP.Conclusions: SNA has a critical influence on hemodynamic and clinical outcomes following EVAR. Appropriate additional

关键词： Severe neck angulation endovascular aneurysm repair Abdominal aortic aneurysm Treatment outcome Hemodynamics

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Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after endovascular Abdomi nal Aortic aneurysm repair:A Meta-Analysis

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Chinese Medical Sciences Journal 2020年第2期35卷 135-141页

作者： Xu Zhang Lei Ji Mengyin Chen Wei Wang Yuehong Zheng Department of Vascular Surgery Peking Union Medical College HospitalChinese Academy of Medical Science&Peking Union Medical CollegeBeijing 100730China

Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the management of type II endoleak remains equipoise.The aim of this study is to compare the technical and clinical success between TA embolization andTL embolization for type II endoleak after EVAR.Methods The protocol was registered(CRD 42018114453)and the electronic databases(Pubmed,Embase,Web of Science,and Cochrane)were systematically searched till March 2019.The search terms included EVAR,type II endoleak,and embolization.The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type II endoleak after EVAR.The technical and clinical success rates were metaanalyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type II endoleaks were included.The pooled odds ratio(OR)of technical success rate for TA vs.TL was 0.56(95%C7,0.10-3.18;P=0.51)and the pooled OR of clinical success rate for TA vs.TL was 0.31(95%CI,0.07-1.29;P=0.11).As a limitation,6 articles were all retrospective studies which may lead to bias.Conclusion Both TA.andTL could be eflective procedure of embolizations to resolve the type II endoleak.The metaanalysis result indicated that TA embolization was not inferior toTL embolization in technical success and clinical success.

关键词： endoleak endovascular aneurysm repair embolization abdominal aortic aneurysm meta-analysis

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An Unusual Case of Deep Vein Thrombosis and Mycotic aneurysms Secondary to Salmonella Bacteraemia

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Case Reports in Clinical Medicine 2022年第3期11卷 37-47页

作者： Malarkodi Suppamutharwyam Anuradha P. Radhakrishnan Department of Internal Medicine Sarikei General Hospital Sarikei Malaysia Department of Internal Medicine Selayang General Hospital Batu Caves Malaysia

Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a high mortality rate involving extra-intestinal foci of infection and mycotic aneurysms. We report the case of a 61-year-old man with poorly controlled diabetes mellitus, hypertension, dyslipidaemia, and congestive heart failure, who presented with unilateral left lower limb swelling, extensive deep vein thrombosis, and concomitant Salmonella bacteraemia. An oral anticoagulant and intravenous antibiotic therapy were initiated. Although the patient remained haemodynamically stable, he complained of constant left lower limb weakness and lower back pain. A computed tomography angiography scan of the thorax and abdomen revealed saccular aneurysms with contained hematoma of the left common iliac artery. The oral anticoagulant was discontinued, and an inferior vena cava filter was inserted as part of the venous thrombosis management. The patient was offered aorto-uni-iliac endovascular aneurysm repair and received intravenous antibiotic therapy, postoperatively, for six weeks. The postoperative blood cultures remained negative, and he was discharged with a course of ciprofloxacin administered orally. However, three months after the surgery, the patient died of recurrent septicaemia. This case illustrates the importance of remaining vigilant for potential endovascular complications of Salmonella bacteraemia, such as mycotic aneurysms and deep vein thrombosis, among high-risk patients. Further, this case highlights the challenges of eliminating Salmonella bacteraemia and its related complications, albeit treating it with both a prolonged course of medical therapy and surgical intervention.

关键词： Deep Vein Thrombosis endovascular aneurysm repair Infective Endarteritis Mycotic aneurysm Salmonella

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Angioscopic Observation of an Endoluminal Stent Graft: CT Imaging versus Angioscopic Imaging

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World Journal of Cardiovascular Surgery 2016年第6期6卷 87-92页

作者： Yasuhiko Kobayashi Takahiro Yamaguchi Sei Komatsu Tomoki Ohara Junichi Yoshida Mitsuhiko Takewa Satoru Takahashi Chikao Yutani Kazuhisa Kodama Shizuo Yoshida Departments of Cardiovascular Surgery Amagasaki Central Hospital Hyogo Japan Departments of Cardiovascular Surgery Kawachi General Hospital Osaka Japan Departments of Cardiology Amagasaki Central Hospital Hyogo Japan Ohara Internal Medicine and Cardiology Clinic Hyogo Japan Departments of Pathology Amagasaki Central Hospital Hyogo Japan Departments of Surgery Amagasaki Central Hospital Hyogo Japan

We could observe the endoluminal stent graft (SG) following thoracic endovascular aneurysm repair (TEVAR) by a coronary artery angioscope and establish intravascular visualization of SG. The patient was a 70-year-old woman with the distal aortic arch aneurysm and the descending aortic aneurysm, and debranching TEVAR were performed. After 12 months follow up, urgent hospitalization was required for chest pain, and cardiac catheter examination with a coronary artery angioscope was performed. The endoluminal SG was observed. The observation in angioscope which is a video image is better than CT that is a still image, and observation in blood vessel or SG is possible. It may be possible to observe the endoluminal SG, allowing potential investigation of an endoleak, or the covering status of the SG with the native aortic vessel wall, or the state of intimal membrane formation in the endoluminal graft.

关键词： Intravascular Visualization Angioscopy Endoluminal Stent Graft endovascular aneurysm repair

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