Five-Year Experience of Interwoven Self-Expanding Stent Implantation in Stenotic Kinking of Below the Knee Prosthetic Bypasses

PURPOSE

The purpose of this study was to evaluate the 5-year real-world results of Supera stent implantation in below the knee prosthetic bypasses (BKPBs). All the procedures were performed because of a history of recurrent thrombosis of the graft and significant stenotic kinking of the prosthesis during knee flexion. A Supera stent was implanted to prevent the next potential BKPB thrombosis.

MATERIALS AND METHODS

Fourteen patients were included in this single-center, retrospective observational cohort study. All patients underwent Supera stent implantation in infrainguinal prosthetic bypass between 2012 and 2017, due to a history of recurrent thrombosis and kinking of the prosthetic bypass.

RESULTS

Prior to Supera stent implantation procedure, all the patients had more than one episode of acute limb ischemia caused by thrombosis of the BKPB. The median number of BKPB thromboses prior to Supera stent implantation was 3 and ranged from 2 to 6. Technical success was achieved in all cases. Primary patency rates at 12, 24, 36 and 60 months were 71.4%, 57.1%, 57.1% and 14.3%, respectively. Secondary patency rates at 12, 24, 36 and 60 months were 78.6%, 64.3%, 64.3% and 35.7%, respectively. One stent fracture was reported during 60-month follow-up. Major amputation was performed in 6 patients in 5-year follow-up.

CONCLUSION

Supera stent in treatment of recurrent thrombosis of BKBP is a safe procedure with acceptable mid-term results. However, larger and comparable prospective studies are needed for broader analysis of this procedure.

The role of compression therapy after endovenous laser ablation (EVLA) - review

<b><br>Introduction:</b> Chronic venous disease (CVD) is a rising problem in western countries. There are several stages of CVD that can be treated with different ways. One of the methods of treating varicosity, C2 stage of CVD, is still developing endovenous laser ablation (EVLA). This method is popular due to its short operation time, less bleeding, quick recovery and no surgical scars. The compression therapy in form of compression stockings has been widely used as a conservative treatment of early stage CVD and it's also used after EVLA. However there are no strong recommendations towards using compression therapy after this kind of surgery.</br> <b><br>Aim and Method:</b> This paper is aimed to review existing knowledge about compression therapy benefits and its recommended time period after EVLA. Search engines used in review: Pubmed and Cochrane.</br> <b><br>Results:</b> Studies focusing on the compression therapy after EVLA of varicose veins have questioned the prolonged use of compression therapy as it brings no additional benefits and might be difficult for patients to adhere. The existing studies recommended the time period no greater than 1-2 weeks. There are no significant changes in reoccurrence rate and return to normal activities between compression and non-compression group. It is proven that compression therapy significantly reduces the postoperative pain and consumption of analgesics.</br> <b><br>Discussion:</b> Compression therapy seems as a safe option for low pain management. There is a need for further research involving the impact of the compression therapy after EVLA, especially in group of low energy delivered settings as the results of treatment are promising.</br>.

Three-Year Real-World Outcomes of Interwoven Nitinol Supera Stent Implantation in Long and Complex Femoropopliteal Lesions

BACKGROUND

Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease.

METHODS

A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients' demographics, lesions characteristics, reintervention rates and patency rates was performed.

RESULTS

The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Mean lesion length was 152.8 ± 94.6 mm. Chronic total occlusions were observed in a majority of lesions. Overall, primary patency rates at 6, 12, 24 and 36 months were 85.0%, 73.6%, 59.2% and 53.2%, respectively.

CONCLUSIONS

The Supera stent is effective in the management of long and complex lesions. The results of patency rates were evaluated to be worse among lesions extending to the popliteal artery.

Supera stent implantation for the treatment of isolated popliteal artery disease systematic review and evaluation of current endovascular strategies

&lt;b&gt;Introduction:&lt;/b&gt; The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical attributes of the vessel lead to higher rates of restenosis, stent fracture, and occlusion. Some surgeons consider the popliteal artery as a no stenting zone. Many specialists favor percutaneous transluminal angioplasty to be the first line of endovascular treatment in the popliteal artery with bail-out stent implantation if the results are suboptimal. The Supera peripheral stent system is a novel stent that has been manufactured with a high degree of flexibility and supposedly might be appropriate for implantation in the popliteal artery. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; Evaluation of the performance of Supera stent in isolated popliteal artery disease in comparison to other methods of treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Methods:&lt;/b&gt; As many as 92 articles were found in the databases and after full-text review, 4 studies matched the inclusion criteria and were evaluated. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Primary patency rates of Supera implantation in an isolated popliteal artery at 12 months ranged from 68% to 90%. In all four studies, no stent fractures were observed. Only one study provided longer follow-up than 12 months and evaluated the performance of the Supera stent 36 months after implantation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; In conclusion, mentioned studies show promising and superior to other stent patency rates of the Supera stent regarding popliteal artery lesions. What is more, no stent fracture is promising regarding longer follow-up. However, more studies with longer follow-ups and direct comparison to other methods are required to fully evaluate Supera&apos;s performance in the popliteal artery.

Nutcracker syndrome - a mini review on current knowledge

Nutcracker syndrome (NCS) seems to be an under-diagnosed condition defined as external compression of the left renal vein and consequent blood outflow impairment. The majority of cases involve the left renal vein entrapment between abdominal aorta and the superior mesenteric artery. The exact epidemiology is unknown due to lack of consensus on diagnostic criteria and often asymptomatic courses. NCS may occur at any age with peak presentation in the second and third decade of life. There is a slight prevalence in females. The most frequent presentations include micro and macroscopic hematuria, orthostatic proteinuria, orthostatic hypotension, flank pain. Patients may develop pelvic congestion syndrome comprising dyspareunia, dysmenorrhea, abdominal pain, pelvic, gluteal, vulvar varicose veins and varicocele in men. Clinical suspicion of NCS based on signs and symptoms, requires imaging confirmation utilising modalities such as doppler ultrasonography, computed tomography and magnetic resonance angiography, intravascular ultrasound and phlebography. Treatment options of NCS range from conservative surveillance to nephrectomy, thus appropriate approach should be based on clinical manifestation and severity of symptoms. Patients presenting with mild to moderate haematuria, and acceptable symptoms should be treated conservatively. In cases of severe symptoms or when conservative management fails, invasive treatment should be considered. Recommended open surgical procedures include left renal vein distal transposition and renal autotransplantation. Endovascular stenting approach seems to be an encouraging solution.  Further long term follow-up is required to create objective treatment guidelines.

COVID, long flights, and deep vein thrombosis: What we know so far

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) pandemic has presently stunted the growth of the airline industry. Despite the setbacks, pre-COVID passenger numbers are forecasted to return by as early as 2024. As the industry recovers, the number of long-distance flights will surely continue to increase like it did before the pandemic. The incidence of venous thromboembolism (VTE) following air travel is also likely to increase. Although not common, the unique environment of air travel exposes individuals with particular health conditions to an elevated risk of acquiring VTEs. Numerous factors increasing the risk of developing VTE related to air travel have been identified, including inherited and acquired flight-related aspects. Non-pharmacological approaches to reduce air travel-related VTEs involve simple foot movements, compression socks and stockings, intermittent pneumatic compression devices, a novel modified airline seat, and foot exercisers. Pharmacological methods include heparins and direct oral anticoagulants. More than 30 reliable articles were evaluated to present the current knowledge regarding air travel-related VTEs, their risk factors, and prophylactic methods. Issues in research methodologies found in the literature were identified and discussed. Further research involving international collaboration projects is recommended. The authors' perspectives regarding long flights in previously infected COVID-19 individuals are also included.

Endoleaks after endovascular abdominal aortic aneurysm repair

Traditional surgical repair and endovascular repair (EVAR) are the treatment options for abdominal aortic aneurysm repair. EVAR as less invasive becomes a significant and widely accepted way of treatment aortic aneurysms with expanding number of procedures. This technique has a lover short-term mortality and a shorter hospital stay but is not free from complications. The most common complication after EVAR are endoleaks. For the first time summarised and assessed in 1997. Although it is often asymptomatic but may cause aneurysm expanding and rupture. Endoleak is defined as persistent blood flow into the aneurysm sac. It can be revealed intra-operatively or during the follow up – CT; arteriography, angio-MRI enables endoleak diagnosis. Usage of duplex sonography is questionable. In this mini-review we summarise endolek diagnostic, classification and treatment options.

Career in vascular surgery – the medical student’s perspective

Aim: Under the supervision of the Department of General and Vascular Surgery of Poznan University of Medical Sciences, a questionnaire was distributed online or as a paper version to medical students (MSs) in order to better understand the attitudes towards surgery as a specialty and to determine the reasons why students do and do not choose vascular surgery as their career path. Materials and methods: The questionnaire was distributed online or as a paper version to MSs in the 3rd, 5th, and 6th year of the PUMS 6-year M.D. program. It provided the data on the year of study, grade point average (GPA), sex, age, respondent’s specialty choice, 33 questions with responses on a 1-5 Likert scale (1 was the least important reason and 5 was the most important reason), and 2 questions with socres between 0 and 4. A total of 136 Polish MSs of PUMS completed the survey. Results: For MSs who choose vascular surgery as their career path, “endovascular capabilities of vascular surgery” and “higher income possibilities than a general surgeon” were the most important reasons. The “poor availability of work in other places than the vascular surgery department of your choice, few such clinics in the region” was the most important reason not to choose vascular surgery. A role of gender was also noted - 13% of male MSs classified gender as an “important factor”, in contrast to 60% of female MSs. Conclusions: The findings of this study might help to develop better strategies to attract future trainees to surgical specialties, particularly vascular surgery, and improve work environment.