BACKGROUND: Cervical lipomas accompanied by neurovascular compression are extremely rare and require surgical treatment in case of appropriate symptoms. The preferable method is gross total resection, as otherwise they tend to recur. Invasive growth is not typical for lipomas. However, large tumors can involve adjacent nerves and vessels and significantly complicate resection.
METHODS: We present a 57-year-old patient who underwent resection of giant soft tissue cervical lipoma invading neurovascular bundle and compressing the oropharynx and esophagus with dysphagia and positional asphyxia. The patient was followed-up for previous 5 years. Resection was necessary due to tumor enlargement with appropriate symptoms. Searching for literature data was performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases.
CONCLUSIONS: Gross total resection of 7-cm tumor was accompanied by mobilization of hypoglossal and vagus nerves, common, external and internal carotid arteries and jugular vein with repositioning of the oropharynx and esophagus. There was mild Horner\'s syndrome in early postoperative period. The patient was discharged in 4 days after surgery with regression of complaints. We found only 5 reports describing giant cervical lipomas invading neurovascular bundle.
CONCLUSIONS: Giant cervical lipomas are extremely rare, and total resection with preservation of critical structures is possible in a specialized hospital.
Липомы, сопровождающиеся компрессией сосудисто-нервного пучка шеи, встречаются крайне редко и требуют хирургического лечения в случаях появления соответствующей симптоматики. Предпочтительным методом является радикальное удаление, так как в противном случае они склонны рецидивировать. Для липом не характерен инвазивный рост, однако, достигая больших размеров, они могут вовлекать в себя прилежащие нервные и сосудистые структуры, что значительно затрудняет радикальную хирургическую резекцию.
UNASSIGNED: В статье представлено наблюдение пациента 57 лет, которому было произведено удаление гигантской липомы мягких тканей шеи, распространяющейся в сосудисто-нервный пучок и приводящей к компрессии ротоглотки, пищевода, дисфагии и позиционной асфиксии при повороте головы. Пациент наблюдался по поводу образования в течение 5 лет, в связи с увеличением образования в динамике и нарастанием жалоб было принято решение об его удалении. Произведен поиск литературы по ключевым словам в научных базах данных PubMed, Medline, EMBASE, Cochrane Library и eLibrary.
UNASSIGNED: В ходе операции опухоль 7 см в диаметре была полностью удалена, из нее выделены и сохранены подъязычный, блуждающий нервы, общая, наружная и внутренняя сонные артерии и яремная вена, сдавленные ротоглотка и пищевод приняли нормальное положение. В раннем послеоперационном периоде отмечалось появление минимально выраженного синдрома Горнера, пациент был выписан из клиники на 4-е сутки после операции с регрессом жалоб. При поиске литературы было найдено лишь 5 работ, описывающих гигантские липомы шеи с вовлечением сосудисто-нервного пучка.
UNASSIGNED: Гигантские липомы шеи встречаются крайне редко, а их радикальное удаление с сохранением критических структур возможно в условиях специализированного стационара.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the safety and feasibility of transradial access for peripheral vascular interventions.
METHODS: MEDLINE and Embase.
METHODS: MEDLINE and Embase databases were searched to June 2023 to identify studies investigating the outcomes of peripheral vascular interventions in lower extremity, carotid, and visceral arteries via transradial vs. transfemoral access. The primary outcome was procedural failure rate. Secondary outcomes were total access site complications, minor and major bleeding, stroke, access vessel occlusion, procedural time, fluoroscopy time, and contrast volume.
RESULTS: Eight randomised controlled trials and 29 observational studies yielded a total of 70 882 patients treated via transradial (n = 2 616) vs. transfemoral access (n = 68 338). The overall failure rate was 2.3 ± 0.7%, and the transradial approach was associated with a statistically significantly higher procedural failure rate than the transfemoral approach (3.9 ± 0.7% vs. 1.0 ± 0.3%; odds ratio [OR] 3.07, 95% confidence interval [CI] 1.84 - 5.12; I2 = 32%; p < .001). Subgroup analysis showed the highest failure rate in lower extremity interventions with 12.4 ± 4.9% for transradial vs. 4.0 ± 1.2% for transfemoral access. Conversely, procedural complications were statistically significantly fewer with transradial access for total access site complications (OR 0.64, 95% CI 0.45 - 0.91; I2 = 36%; p = .010). Minor bleeding was statistically significantly less with the transradial approach (OR 0.52, 95% CI 0.31 - 0.86; I2 = 30%; p = .010), whereas major bleeding and stroke rates were similar. Transradial access had more access vessel occlusion than transfemoral access (1.9% ± 0.5% vs. < 0.1% ± 0.0%; p = .004), although most remained asymptomatic. Procedural time, fluoroscopy time, and contrast volume were all comparable. GRADE certainty was low to moderate in most outcomes.
CONCLUSIONS: The transradial approach was associated with a higher procedural failure rate. Total access site complications and minor bleeding were lower with the transradial approach, albeit with more frequent access vessel occlusion. Transradial access may be a feasible and safe approach; however, appropriate patient selection is imperative.

Carotid complications resulting from extra-luminal migration of ingested foreign bodies (FB) are rare but potentially life-threatening. Previous data on the topic predominantly comprises isolated case reports, leaving a gap in comprehensive evidence necessary to guide clinical decision-making. In this article, we offer a narrative review alongside a novel case report, aimed at providing a broad, evidence-based perspective on the topic to guide clinical practice. The search strategy employed keywords related to carotid artery complications from ingested FB across the following electronic databases: PubMed, Scopus, Google Scholar, and Cochrane Central. Screening involved standardized data extraction by two independent reviewers, with a focus on abstracts meeting inclusion criteria and excluding non-English literature and non-relevant studies from further analysis. Moreover, we present a novel case report on the topic that was successfully managed using a unique surgical approach. Overall, a total of sixteen case reports were finally included, data on clinical presentations, diagnostic strategies and findings, surgical management and outcome were extracted, tabulated, and discussed. In carotid complications from extra-luminal migration of ingested FB, high clinical suspicion is crucial due to potentially mild symptoms and negative first-level examinations. Computed tomography (CT) scan plays a pivotal role for accurate diagnosis and surgical planning, along with neck ultrasound to detect complications. Tailored surgical strategies based on the severity of carotid involvement, including venous patch grafts in severe vessels involvement, are crucial for optimal patient outcomes. As a novelty, in our case report, carotid shunt was successfully employed instead of prolonged carotid clamping to reduce the risk of associated neurological sequelae. It could be concluded that, diagnosis and managing carotid complications from extra-luminal migration of ingested FB remains challenging and a multidisciplinary approach is warranted.

OBJECTIVE: The vertical level of carotid bifurcation (CB) is commonly indicated at the superior margin of the thyroid cartilage. Few studies observed the CB vertical topography. It was aimed at studying the vertical location of the CB as referred to vertebral and anterior cervical landmarks.
METHODS: An archived lot of 147 computed tomography angiograms was documented for the vertical level of CB referred to vertebral and anterior cervical landmarks. The topography of the CB in relation to anterior landmarks was classified into seven types: (1) at the superior margin of the thyroid cartilage; (2) between the hyoid and the thyroid cartilage; (3) at the hyoid level; (4) between the hyoid and mandible; (5) subgonial or supragonial CB; (6) lower cervical level; (7) intrathoracic.
RESULTS: The most common locations of CB were at C3 (27.21%), C3/C4 (26.19%) and C4 (25.51%). Bilateral symmetry of CB was found in 51.7%, except for C2 and C5/C6. Type 7 was not found, type 3 occurred in 39.12%, type 2 in 24.49%, type 1 in 13.95%, type 4 in 13.61%, type 5 in 6.12%, and type 6 in 2.72% (294 CBs). Bilateral symmetry of anterior types was found in 59.86%. Statistically significant correlations were found between sex and both left and right types and vertebral levels of CB.
CONCLUSIONS: The vertical topography of the CB is highly variable and has sex-related specificity. This detail should be included in the teaching of anatomy. Surgeons and interventionists should better document the carotid anatomy on a case-by-case basis.

BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral access is difficult or impossible to obtain.
METHODS: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023482842). This meta-analysis was performed to compare the safety of the transcarotid and trans-axillary/subclavian approach for TAVR including studies from inception to October 2023.
RESULTS: Seven studies with a total of 6227 patients were included in the analysis (TCa: 2566; TAx/Sc: 3661). Transcarotid TAVR approach had a favorable trend for composite of stroke and all-cause mortality (OR 0.79, CI 0.60-1.04), all-cause mortality, stroke, major vascular complication, and new requirement of permanent pacemaker though those were statistically insignificant. On sub-analysis of the results of the studies based on the territory (USA vs French), composite outcome of all cause mortality, stroke and major bleeding (OR 0.54, CI 0.54-0.81), composite of stroke and all cause mortality (OR 0.64, CI 0.50-0.81), and stroke/TIA (OR 0.53, CI 0.39-0.73) showed lower odds of occurrence among patient managed with TCa approach in the American cohort.
CONCLUSIONS: Overall, transcarotid approach had favorable though statistically insignificant odds for composite (stroke and all-cause mortality) and individual outcomes (stroke, all-cause mortality, etc.). There are significant variations in observed outcomes based on study\'s geographic location. Large prospective randomized clinical trials comparing the two approaches with representative samples are necessary to guide the clinicians in choosing among these approaches.

BACKGROUND: A noninvasive and accurate method of determining fluid responsiveness in ventilated patients would help to mitigate unnecessary fluid administration. Although carotid ultrasound has been previously studied for this purpose, several studies have recently been published. We performed an updated systematic review and meta-analysis to evaluate the accuracy of carotid ultrasound as a tool to predict fluid responsiveness in ventilated patients.
METHODS: Studies eligible for review investigated the accuracy of carotid ultrasound parameters in predicting fluid responsiveness in ventilated patients, using sensitivity and specificity as markers of diagnostic accuracy (International Prospective Register of Systematic Reviews [PROSPERO] CRD42022380284). All included studies had to use an independent method of determining cardiac output and exclude spontaneously ventilated patients. Six bibliographic databases and 2 trial registries were searched. Medline, Embase, Emcare, APA PsycInfo, CINAHL, and the Cochrane Library were searched on November 4, 2022. Clinicaltrials.gov and Australian New Zealand Clinical Trials Registry were searched on February 24, 2023. Results were pooled, meta-analysis was conducted where possible, and hierarchical summary receiver operating characteristic models were used to compare carotid ultrasound parameters. Bias and evidence quality were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines.
RESULTS: Thirteen prospective clinical studies were included (n = 648 patients), representing 677 deliveries of volume expansion, with 378 episodes of fluid responsiveness (58.3%). A meta-analysis of change in carotid Doppler peak velocity (∆CDPV) yielded a sensitivity of 0.79 (95% confidence interval [CI], 0.74-0.84) and a specificity of 0.85 (95% CI, 0.76-0.90). Risk of bias relating to recruitment methodology, the independence of index testing to reference standards and exclusionary clinical criteria were evaluated. Overall quality of evidence was low. Study design heterogeneity, including a lack of clear parameter cutoffs, limited the generalizability of our results.
CONCLUSIONS: In this meta-analysis, we found that existing literature supports the ability of carotid ultrasound to predict fluid responsiveness in mechanically ventilated adults. ∆CDPV may be an accurate carotid parameter in certain contexts. Further high-quality studies with more homogenous designs are needed to further validate this technology.

This systematic review aimed to identify sex-specific outcomes in men and women after carotid endarterectomy (CEA) and carotid artery stenting (CAS), including transfemoral and transcarotid. A search of literature published from January 2000 through December 2022 was conducted using key terms attributed to carotid interventions on PubMed. Studies comparing outcome metrics post intervention (ie, myocardial infarction [MI], cerebral vascular accident [CVA] or stroke, and long-term mortality) among male and female patients were reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Overall, all studies reported low rates of perioperative complications. Among the studies that did not stratify outcomes by the preoperative symptom status, there were no significant sex differences in rates of perioperative strokes or MIs. Two studies, however, noted a higher rate of 30-day mortality in male patients undergoing CEA than in female patients. Analysis of asymptomatic patients undergoing CEA revealed no difference in perioperative MIs (female: 0% to 1.8% v male: 0.4% to 4.3%), similar rates of CVAs (female: 0.8% to 5% v male: 0.8% to 4.9%), and no significant differences in the long-term mortality outcomes. Alternatively, symptomatic patients undergoing CEA reported a higher rate of CVAs in female patients vs. male patients (7.7% v 6.2%) and showed a higher rate of death in female patients (1% v 0.7%). Among studies that did not stratify outcome by symptomatology, there was no difference in the 30-day outcomes between sexes for patients undergoing CAS. Asymptomatic patients undergoing CAS demonstrated similar incident rates across perioperative MIs (female: 0% to 5.9% v male: 0.28% to 3.3%), CVAs (female: 0.5% to 4.1% v male: 0.4% to 6.2%), and long-term mortality outcomes (female: 0% to 1.75% v male: 0.2% to 1.5%). Symptomatic patients undergoing CAS similarly reported higher incidences of perioperative MIs (female: 0.3% to 7.1% v male: 0% to 5.5%), CVAs (female: 0% to 9.9% v male: 0% to 7.6%), and long-term mortality outcomes (female: 0.6% to 7.1% v male: 0.5% to 8.2%). Sex-specific differences in outcomes after major vascular procedures are well recognized. Our review suggests that symptomatic female patients have a higher incidence of neurologic and cardiac events after carotid interventions, but that asymptomatic patients do not.

BACKGROUND: Carotid webs (CaWs) are increasingly recognized as a cause of cryptogenic acute ischemic stroke (AIS). Due to the risk of recurrent ischemic stroke associated with CaW, it is important to identify them. Although several studies report digital subtraction angiography and computerized tomography angiography (CTA) to be better at diagnosing CaW than Doppler ultrasound (DUS), it remains to be defined which is the best radiological method to diagnose CaW. Our aim was to evaluate sensitivity and accuracy of DUS compared to CTA for CaW diagnosis.
METHODS: We searched PUBMED and EMBASE databases from inception through August 2022. We included studies with patients with CaW diagnosed by DUS and/or CTA, in which both methods were used in each patient. Demographic characteristics, diagnostic reports of each method, and histology reports were collected. Descriptive analysis and sensitivity and accuracy estimates were made to evaluate DUS compared to CTA.
RESULTS: We included 27 articles in the systematic review (121 patients with CaW). DUS identified 94 patients with CaW and CTA 116 patients. DUS missed diagnosis in 22.3% (27 patients) and CTA did not identify CaW detected by DUS in 4.13% (5 patients). Accuracy rate between DUS and CTA was 73.6% (95% CI: 64.8-81.2%). Sensitivity of DUS to diagnose CaW compared to CTA was 76.7% (95% CI: 68.0-84.1%). Most common misdiagnosis with DUS was normal exam (44.4%), atherosclerosis (22.2%), and dissection (22.2%).
CONCLUSIONS: The sensitivity and accuracy of DUS to diagnosis of CaW were moderate. It might detect CaW in some cases in which it was not identified by CTA. Increased recognition of CaW and specific ultrasound protocols may enhance diagnosis of CaW by DUS.

Endovascular thrombectomies (EVTs) are the current standard of care therapy for treating acute ischemic strokes. While access through the femoral or radial arteries is routine, up to 20% of EVTs through these sites are unable to access the cerebral vasculature on the first pass. These shortcomings are commonly due to tortuous vasculature, atherosclerotic arteries, and type III aortic arch, seen especially in the elderly population. Recent studies have shown the benefits of accessing the cerebral vasculature through a percutaneous direct carotid puncture (DCP), which can reduce the time of the procedure by half. However, current vascular closure devices (VCDs) designed for the femoral artery are not suited to close the carotid artery due to the anatomical differences. This unmet clinical need further limits a DCP approach. Thus, to foster safe adoption of this potential approach, a VCD designed specifically for the carotid artery is needed. In this review, we outline the major biomechanical properties and shortcomings of current VCDs and propose the requirements necessary to effectively design and develop a carotid closure device.

UNASSIGNED: The relationship between cardiovascular disorders and nonalcoholic fatty liver disease (NAFLD) has been extensively studied. To better pool this data and make a more definite conclusion, we performed a meta-analysis to evaluate the association between NAFLD and the thickness of media and intima of carotid artery (CIMT) and cardiovascular disorders.
UNASSIGNED: We searched PubMed, Ovid, Scopus, ProQuest, Web of Science, and the Cochrane Library, and analyzed the pooled data using R studio and the \"metafor\" package.
UNASSIGNED: The final analysis included a total of 59 studies with 16,179 cases and 26,120 control individuals. NAFLD was shown to be associated with an increase of 0.1231 mm (20.6%) in carotid artery intima-media thickness (CIMT) (p = 0.002, 95% confidence interval [CI]: 0.0462-0.2000) in individuals with NAFLD. The prevalence of atherosclerotic plaques in the carotid arteries and the occurrence of NAFLD are significantly correlated, according to a meta-analysis based on 17 distinct studies (p = 0.001, 1.28-1.43, 95% CI, odds ratio = 1.356).
UNASSIGNED: Patients with increased CIMT are considerably more likely to have NAFLD. Large prospective investigations are required to corroborate these findings and their prognostic significance, along with the effectiveness of the available interventions.