Purpose: Recent studies suggested that continuous clotting renewal in thrombi plays a central role in sac enlargement after endovascular aneurysm repair (EVAR). We reviewed patients with persistent type 2 endoleak (T2EL) to estimate the impact of D-dimer level on sac enlargement.
Methods: A retrospective review of elective EVAR for infrarenal abdominal aortic aneurysm performed between June 2007 and February 2020. Persistent T2EL was defined as T2EL confirmed at both the 6 and 12 month contrast-enhanced computed tomography (CECT) follow-ups. "Isolated" T2EL was defined as T2EL without other types of endoleak within 12 months. Patients with >2 year follow-up, persistent isolated T2ELs, and D-dimer level data at 1 year (DD1Y) were included. Patients with any reintervention within 12 months were excluded. The association between DD1Y and aneurysm enlargement (AnE), defined as a ≥5 mm diameter increase, within 5 years was analyzed. Among 761 conventional EVAR, 515 patients had >2 years of follow-up. Thirty-three patients with any reintervention within 12 months and 127 patients without CECT at either 6 or 12 months were excluded. Among 131 patients with persistent isolated T2ELs, 74 patients with DD1Y data were enrolled. During a 37 month median follow-up [25-60, IQR], 24 AnEs were observed. In the AnE patients, the median DD1Y was significantly higher than that in the other patients (12.30 [6.88-21.90] vs 7.62 [4.41-13.00], P=0.024). ROC curve analysis indicated that the optimal cutoff point of DD1Y for AnE was 5.5 µg/mL (AUC=0.681). In univariate analysis, angulated neck, occlusion of the inferior mesenteric artery, and DD1Y≥5.5 µg/mL were significantly associated with AnE (P= 0.037, 0.038, and 0.010). Cox regression analysis revealed that DD1Y≥5.5 µg/mL was correlated with AnE (P=0.042, HR [95% CI] 4.520 [1.056-19.349]).
Conclusion: A 1 year higher D-dimer level can potentially predict AnE within 5 years in persistent T2EL patients. AnE was considered improbable when the D-dimer level was low enough.Clinical ImpactThe present study suggests that a 1-year higher D-dimer level could potentially predict aneurysm expansion within 5 years in patients with persistent type 2 endoleak (T2EL). On the other hand, aneurysm expansion was considered unlikely if the D-dimer level was low enough.As there are many patients with T2EL who require regular follow-up, any predictor of future aneurysm expansion could be of great help in conserving medical resources. In patients with a low likelihood of future expansion, we might consider delaying follow-up, similar to patients with sac shrinkage.
{"title":"The Association Between the D-dimer Level at 1 Year After EVAR and Sac Diameter Change in Patients With Persistent Type 2 Endoleak.","authors":"Masayuki Sugimoto, Tomohiro Sato, Shuta Ikeda, Yohei Kawai, Kiyoaki Niimi, Hiroshi Banno","doi":"10.1177/15266028231170165","DOIUrl":"10.1177/15266028231170165","url":null,"abstract":"<p><strong>Purpose: </strong>Recent studies suggested that continuous clotting renewal in thrombi plays a central role in sac enlargement after endovascular aneurysm repair (EVAR). We reviewed patients with persistent type 2 endoleak (T2EL) to estimate the impact of D-dimer level on sac enlargement.</p><p><strong>Methods: </strong>A retrospective review of elective EVAR for infrarenal abdominal aortic aneurysm performed between June 2007 and February 2020. Persistent T2EL was defined as T2EL confirmed at both the 6 and 12 month contrast-enhanced computed tomography (CECT) follow-ups. \"Isolated\" T2EL was defined as T2EL without other types of endoleak within 12 months. Patients with >2 year follow-up, persistent isolated T2ELs, and D-dimer level data at 1 year (DD1Y) were included. Patients with any reintervention within 12 months were excluded. The association between DD1Y and aneurysm enlargement (AnE), defined as a ≥5 mm diameter increase, within 5 years was analyzed. Among 761 conventional EVAR, 515 patients had >2 years of follow-up. Thirty-three patients with any reintervention within 12 months and 127 patients without CECT at either 6 or 12 months were excluded. Among 131 patients with persistent isolated T2ELs, 74 patients with DD1Y data were enrolled. During a 37 month median follow-up [25-60, IQR], 24 AnEs were observed. In the AnE patients, the median DD1Y was significantly higher than that in the other patients (12.30 [6.88-21.90] vs 7.62 [4.41-13.00], P=0.024). ROC curve analysis indicated that the optimal cutoff point of DD1Y for AnE was 5.5 µg/mL (AUC=0.681). In univariate analysis, angulated neck, occlusion of the inferior mesenteric artery, and DD1Y≥5.5 µg/mL were significantly associated with AnE (P= 0.037, 0.038, and 0.010). Cox regression analysis revealed that DD1Y≥5.5 µg/mL was correlated with AnE (P=0.042, HR [95% CI] 4.520 [1.056-19.349]).</p><p><strong>Conclusion: </strong>A 1 year higher D-dimer level can potentially predict AnE within 5 years in persistent T2EL patients. AnE was considered improbable when the D-dimer level was low enough.Clinical ImpactThe present study suggests that a 1-year higher D-dimer level could potentially predict aneurysm expansion within 5 years in patients with persistent type 2 endoleak (T2EL). On the other hand, aneurysm expansion was considered unlikely if the D-dimer level was low enough.As there are many patients with T2EL who require regular follow-up, any predictor of future aneurysm expansion could be of great help in conserving medical resources. In patients with a low likelihood of future expansion, we might consider delaying follow-up, similar to patients with sac shrinkage.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"374-381"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9447881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-05-16DOI: 10.1177/15266028231173311
Silvan Jungi, Dimitrios D Papazoglou, Hon-Lai Chan, Jürg Schmidli, Vladimir Makaloski
Purpose: We describe the feasibility and early results of a novel endovascular approach with a surgeon-modified fenestrated iliac stent graft to preserve pelvic perfusion in patients with iliac aneurysms not suitable for iliac branch devices (IBDs).
Technique: Seven high-risk patients, median age 76 years (range 63-83), with a complex aortoiliac anatomy with contraindications for commercially available IBDs were treated with a novel surgeon-modified fenestrated iliac stent graft between August 2020 and November 2021. The modified device was built using an iliac limb stent graft (Endurant II Stent Graft; Medtronic), which was partially deployed, surgically fenestrated with a scalpel, reinforced, re-sheathed, and inserted via femoral access. The internal iliac artery was cannulated and bridged with a covered stent. Technical success rate was 100%. After a median follow-up period of 10 months, there was 1 type II endoleak and no migrations, stent fractures, or loss of device integrity. One iliac limb occlusion occurred after 7 months, which needed a secondary endovascular intervention, restoring patency.
Conclusion: Surgeon-modified fenestrated iliac stent graft is feasible and might be used as an alternative in patients with a complex iliac anatomy not suitable to commercially available IBDs. Long-term follow-up is needed to evaluate stent graft patency and potential complications.Clinical ImpactSurgeon modified fenetrated iliac stent grafts might be a promising alternative to iliac branch devices, extending endovascular solutions to a broader patient population with complex aorto-iliac anatomies preserving antegrade internal iliac artery perfusion. It is possible to treat small iliac bifurcations and large angulations of the iliac bifurcation safely and there is no need for a contralateral or upper-extremity access.
目的:我们描述了一种新的血管内入路的可行性和早期结果，即外科改良的开窗髂支架移植，以保持不适合髂分支装置(ibd)的髂动脉瘤患者盆腔灌注。技术:在2020年8月至2021年11月期间，7名高危患者，中位年龄76岁(63-83岁)，具有复杂的主动脉-髂解剖结构，并有市售ibd的禁忌症，接受了一种新型手术改良的开窗髂支架移植。该改良装置采用髂肢体支架(Endurant II stent graft;美敦力(Medtronic))，部分部署，手术开窗，用手术刀，加强，重新鞘，并通过股骨通道插入。髂内动脉插管，用覆盖支架桥接。技术成功率100%。中位随访10个月后，有1例II型内漏，无移位、支架骨折或器械完整性丧失。7个月后发生1例髂肢体闭塞，需要二次血管内介入，恢复通畅。结论:外科改良的开窗髂骨支架移植是可行的，可以作为一种替代方案，用于髂解剖结构复杂，不适合市售ibd的患者。需要长期随访来评估支架通畅和潜在的并发症。临床影响:外科医生改良的有孔髂支架移植可能是髂分支装置的一个有希望的替代方案，将血管内解决方案扩展到更广泛的患者群体，这些患者具有复杂的主动脉-髂解剖结构，保留了顺行髂内动脉灌注。可以安全地治疗小的髂分叉和大角度的髂分叉，不需要对侧或上肢通路。
{"title":"Novel Surgeon-Modified Fenestrated Iliac Stent Graft.","authors":"Silvan Jungi, Dimitrios D Papazoglou, Hon-Lai Chan, Jürg Schmidli, Vladimir Makaloski","doi":"10.1177/15266028231173311","DOIUrl":"10.1177/15266028231173311","url":null,"abstract":"<p><strong>Purpose: </strong>We describe the feasibility and early results of a novel endovascular approach with a surgeon-modified fenestrated iliac stent graft to preserve pelvic perfusion in patients with iliac aneurysms not suitable for iliac branch devices (IBDs).</p><p><strong>Technique: </strong>Seven high-risk patients, median age 76 years (range 63-83), with a complex aortoiliac anatomy with contraindications for commercially available IBDs were treated with a novel surgeon-modified fenestrated iliac stent graft between August 2020 and November 2021. The modified device was built using an iliac limb stent graft (Endurant II Stent Graft; Medtronic), which was partially deployed, surgically fenestrated with a scalpel, reinforced, re-sheathed, and inserted via femoral access. The internal iliac artery was cannulated and bridged with a covered stent. Technical success rate was 100%. After a median follow-up period of 10 months, there was 1 type II endoleak and no migrations, stent fractures, or loss of device integrity. One iliac limb occlusion occurred after 7 months, which needed a secondary endovascular intervention, restoring patency.</p><p><strong>Conclusion: </strong>Surgeon-modified fenestrated iliac stent graft is feasible and might be used as an alternative in patients with a complex iliac anatomy not suitable to commercially available IBDs. Long-term follow-up is needed to evaluate stent graft patency and potential complications.Clinical ImpactSurgeon modified fenetrated iliac stent grafts might be a promising alternative to iliac branch devices, extending endovascular solutions to a broader patient population with complex aorto-iliac anatomies preserving antegrade internal iliac artery perfusion. It is possible to treat small iliac bifurcations and large angulations of the iliac bifurcation safely and there is no need for a contralateral or upper-extremity access.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"342-349"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9475024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-06-06DOI: 10.1177/15266028231179414
Tilo Kölbel, Petroula Nana, Jose I Torrealba, Giuseppe Panuccio, Christian-Alexander Behrendt, Konstantinos Spanos
<p><strong>Purpose: </strong>Sarcopenia has been identified as an independent predictor of mortality in patients with infrarenal abdominal aortic aneurysm and may also affect outcomes in patients with complex aortic pathologies. The aim of this study was to assess sarcopenia, combined with the American Society of Anesthesiologists (ASA) score, as predictors for spinal cord ischemia (SCI) in patients treated with the t-Branch off-the-shelf device.</p><p><strong>Materials and methods: </strong>A single-center retrospective observational study was conducted including elective and urgent patients managed with the t-Branch device (Cook Medical, Bjaeverskov, Denmark) between January 1, 2018, and September 30, 2020. Data were collected according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. The psoas muscle area (cm<sup>2</sup>) and attenuation (Hounsfield units, HU) were measured in the arterial phase of the pre-operative computed tomography angiography for each patient. The lean psoas muscle area (LPMA) was used to stratify patients into 3 groups, and further stratification was performed with a combination of the ASA score and LPMA.</p><p><strong>Results: </strong>Eighty patients were included (mean age at 71±9 years; 62.5% males). Thoracoabdominal aneurysms were managed in 72.5% of cases (42.5% for type I-III). Thirty-seven (46%) were treated urgently. Eleven patients died within 30 days (14%). Twelve patients (15%) presented SCI of any severity. Among the LPMA groups, the only statistically significant difference was recorded in age; group 3 was older compared with groups 1 and 2 (67.1 years vs 72.1 years vs 73.5 years, p=0.004). After ASA combined LPMA categorization, 28 patients were considered as low risk, 16 as moderate risk, and 36 as high risk. A statistically significant difference was recorded in terms of SCI (3.5% [1/28] in low risk vs 12.5% [2/16] in moderate risk vs 25% [9/36] in high risk, p=0.049). Multivariate analysis showed that moderate-risk patients were at risk to evolve to SCI (p=0.04).</p><p><strong>Conclusions: </strong>Low-risk patients, with ASA score I-II or LPMA>350cm<sup>2</sup>HU, are at lower risk for developing SCI after BEVAR using the t-Branch device. Patients' stratification according to the combination of ASA score and psoas muscle area and attenuation may identify a group at higher risk of SCI after branched endovascular aneurysm repair.Clinical ImpactSarcopenia has been identified as a factor of increased mortality in patients managed for aortic aneurysm repair. However, significant heterogeneity has been recorded in the tools assessing its presence. In this analysis, an already used method, combining the ASA score and psoas muscle area and attenuation, has been used to assess the impact of sarcopenia in patients managed with the t-branch device. This analysis showed that patients at low risk, with an ASA score I-II or LPMA>350cm2HU were at lower risk to evolve spi
{"title":"The Association of Sarcopenia and ASA Score to Spinal Cord Ischemia in Patients Treated With the t-Branch Device.","authors":"Tilo Kölbel, Petroula Nana, Jose I Torrealba, Giuseppe Panuccio, Christian-Alexander Behrendt, Konstantinos Spanos","doi":"10.1177/15266028231179414","DOIUrl":"10.1177/15266028231179414","url":null,"abstract":"<p><strong>Purpose: </strong>Sarcopenia has been identified as an independent predictor of mortality in patients with infrarenal abdominal aortic aneurysm and may also affect outcomes in patients with complex aortic pathologies. The aim of this study was to assess sarcopenia, combined with the American Society of Anesthesiologists (ASA) score, as predictors for spinal cord ischemia (SCI) in patients treated with the t-Branch off-the-shelf device.</p><p><strong>Materials and methods: </strong>A single-center retrospective observational study was conducted including elective and urgent patients managed with the t-Branch device (Cook Medical, Bjaeverskov, Denmark) between January 1, 2018, and September 30, 2020. Data were collected according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. The psoas muscle area (cm<sup>2</sup>) and attenuation (Hounsfield units, HU) were measured in the arterial phase of the pre-operative computed tomography angiography for each patient. The lean psoas muscle area (LPMA) was used to stratify patients into 3 groups, and further stratification was performed with a combination of the ASA score and LPMA.</p><p><strong>Results: </strong>Eighty patients were included (mean age at 71±9 years; 62.5% males). Thoracoabdominal aneurysms were managed in 72.5% of cases (42.5% for type I-III). Thirty-seven (46%) were treated urgently. Eleven patients died within 30 days (14%). Twelve patients (15%) presented SCI of any severity. Among the LPMA groups, the only statistically significant difference was recorded in age; group 3 was older compared with groups 1 and 2 (67.1 years vs 72.1 years vs 73.5 years, p=0.004). After ASA combined LPMA categorization, 28 patients were considered as low risk, 16 as moderate risk, and 36 as high risk. A statistically significant difference was recorded in terms of SCI (3.5% [1/28] in low risk vs 12.5% [2/16] in moderate risk vs 25% [9/36] in high risk, p=0.049). Multivariate analysis showed that moderate-risk patients were at risk to evolve to SCI (p=0.04).</p><p><strong>Conclusions: </strong>Low-risk patients, with ASA score I-II or LPMA>350cm<sup>2</sup>HU, are at lower risk for developing SCI after BEVAR using the t-Branch device. Patients' stratification according to the combination of ASA score and psoas muscle area and attenuation may identify a group at higher risk of SCI after branched endovascular aneurysm repair.Clinical ImpactSarcopenia has been identified as a factor of increased mortality in patients managed for aortic aneurysm repair. However, significant heterogeneity has been recorded in the tools assessing its presence. In this analysis, an already used method, combining the ASA score and psoas muscle area and attenuation, has been used to assess the impact of sarcopenia in patients managed with the t-branch device. This analysis showed that patients at low risk, with an ASA score I-II or LPMA>350cm2HU were at lower risk to evolve spi","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"460-466"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9586269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-06-07DOI: 10.1177/15266028231179426
Emiel W M Huistra, Ignace F J Tielliu, G Matthijs Kater, Gijs C Bloemsma, Clark J Zeebregts
Purpose: To present a rare cause of type III endoleak via the left renal artery (LRA) fenestration following fenestrated endovascular aneurysm repair (FEVAR) and to describe a successful reintervention for treating this endoleak.
Technique: The patient presented with a type IIIc endoleak following FEVAR, due to inadvertent placement of the LRA bridging balloon expandable covered stent (BECS) via the superior mesenteric artery (SMA) fenestration, but deployed outside the SMA fenestration. The proximal part of the BECS was positioned outside of the main body. This caused a type IIIc endoleak via the open LRA fenestration. Reintervention was performed by relining the LRA with a new BECS. First, access to the lumen of the previously placed BECS was gained using a re-entry catheter, followed by placement of a new BECS via the LRA fenestration. Completion angiography, and computerized tomography angiography (CTA) at 3 months follow-up showed total obliteration of the endoleak and patency of the LRA.
Conclusion: Placement of a bridging stent via an incorrect fenestration during FEVAR is a rare cause of type III endoleak. In certain cases, successful treatment of such an endoleak could be achieved by perforation and relining of the misplaced BECS via the correct fenestration of the target vessel.Clinical ImpactTo our best knowledge, a type IIIc endoleak following fenestrated endovascular aneurysm repair, due to placement of a bridging covered stent through an incorrect fenestration and deployed short of the fenestration, has not been described before. Reintervention was performed with perforation of the previously placed covered stent and relining using a new bridging covered stent. The technique presented here was successful for treating the endoleak in this case and could help guide clinicians when dealing with this or similar complications.
{"title":"Relining of a Bridging Covered Stent to Treat a Rare Cause of Type IIIc Endoleak Following Fenestrated Endovascular Aneurysm Repair.","authors":"Emiel W M Huistra, Ignace F J Tielliu, G Matthijs Kater, Gijs C Bloemsma, Clark J Zeebregts","doi":"10.1177/15266028231179426","DOIUrl":"10.1177/15266028231179426","url":null,"abstract":"<p><strong>Purpose: </strong>To present a rare cause of type III endoleak via the left renal artery (LRA) fenestration following fenestrated endovascular aneurysm repair (FEVAR) and to describe a successful reintervention for treating this endoleak.</p><p><strong>Technique: </strong>The patient presented with a type IIIc endoleak following FEVAR, due to inadvertent placement of the LRA bridging balloon expandable covered stent (BECS) via the superior mesenteric artery (SMA) fenestration, but deployed outside the SMA fenestration. The proximal part of the BECS was positioned outside of the main body. This caused a type IIIc endoleak via the open LRA fenestration. Reintervention was performed by relining the LRA with a new BECS. First, access to the lumen of the previously placed BECS was gained using a re-entry catheter, followed by placement of a new BECS via the LRA fenestration. Completion angiography, and computerized tomography angiography (CTA) at 3 months follow-up showed total obliteration of the endoleak and patency of the LRA.</p><p><strong>Conclusion: </strong>Placement of a bridging stent via an incorrect fenestration during FEVAR is a rare cause of type III endoleak. In certain cases, successful treatment of such an endoleak could be achieved by perforation and relining of the misplaced BECS via the correct fenestration of the target vessel.Clinical ImpactTo our best knowledge, a type IIIc endoleak following fenestrated endovascular aneurysm repair, due to placement of a bridging covered stent through an incorrect fenestration and deployed short of the fenestration, has not been described before. Reintervention was performed with perforation of the previously placed covered stent and relining using a new bridging covered stent. The technique presented here was successful for treating the endoleak in this case and could help guide clinicians when dealing with this or similar complications.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"357-362"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9595802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-06-06DOI: 10.1177/15266028231179423
Pedro J F Neves, Thomas Brett Reece, Donald L Jacobs, Emily A Malgor, Rafael D Malgor
{"title":"Aortic Remodeling Following Aortic Dissection: The Time for Standardization is Now.","authors":"Pedro J F Neves, Thomas Brett Reece, Donald L Jacobs, Emily A Malgor, Rafael D Malgor","doi":"10.1177/15266028231179423","DOIUrl":"10.1177/15266028231179423","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"271-275"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9958335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-06-21DOI: 10.1177/15266028231182229
Mingwei Wu, Li Liu, Jiang Xiong
Type B aortic dissection (TBAD) is associated with high mortality. Multiple in vitro models and computational fluid dynamics (CFD) simulations have been used to mimic the hemodynamic characteristics of TBAD to inform more effective therapeutic strategies. However, the results of these experiments are rarely used in clinical practice due to concerns about their accuracy and reliability. The development of 4-dimensional magnetic resonance imaging (4D-MRI) allows to verify the accuracy of the results of in vitro models and CFD simulations. This review provides an overview of the strengths, limitations, and accuracy of in vitro models, CFD simulations, and in vivo 4D flow MRI for the study of TBAD hemodynamics.Clinical Impact1. Hemodynamic of TBAD is important to improve the long-term outcome of TEVAR.2. This review provides an overview of the in-vitro for the hemodynamic study of TBAD.3. The accuracy and validity of in-vitro TBAD experiments should be further studied.
{"title":"In Vitro Studies on Hemodynamics of Type B Aortic Dissection: Accuracy and Reliability.","authors":"Mingwei Wu, Li Liu, Jiang Xiong","doi":"10.1177/15266028231182229","DOIUrl":"10.1177/15266028231182229","url":null,"abstract":"<p><p>Type B aortic dissection (TBAD) is associated with high mortality. Multiple in vitro models and computational fluid dynamics (CFD) simulations have been used to mimic the hemodynamic characteristics of TBAD to inform more effective therapeutic strategies. However, the results of these experiments are rarely used in clinical practice due to concerns about their accuracy and reliability. The development of 4-dimensional magnetic resonance imaging (4D-MRI) allows to verify the accuracy of the results of in vitro models and CFD simulations. This review provides an overview of the strengths, limitations, and accuracy of in vitro models, CFD simulations, and in vivo 4D flow MRI for the study of TBAD hemodynamics.Clinical Impact1. Hemodynamic of TBAD is important to improve the long-term outcome of TEVAR.2. This review provides an overview of the in-vitro for the hemodynamic study of TBAD.3. The accuracy and validity of in-vitro TBAD experiments should be further studied.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"303-311"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9669965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-06-16DOI: 10.1177/15266028231179864
D'Oria Mario, Grandi Alessandro, Pratesi Giovanni, Parlani Gianbattista, Giudice Rocco, Gargiulo Mauro, Mangialardi Nicola, Chiesa Roberto, Lepidi Sandro, Bertoglio Luca
Objective: The use of steerable sheaths to allow total transfemoral access (TFA) of branched endovascular repair (BEVAR) of thoracoabdominal aortic aneurysms has been proposed as an alternative to upper extremity access (UEA); however, multicenter results from high-volume aortic centers are lacking.
Materials and methods: The Total Transfemoral Branched Endovascular Thoracoabdominal Aortic Repair (TORCH2) study is a physician-initiated, national, multicenter, retrospective, observational registry (Clinicaltrials.gov identifier: NCT04930172) of patients undergoing BEVAR with a TFA for the cannulation of reno-visceral target vessels (TV). The study endpoints, classified according to Society for Vascular Surgery reporting standards, were (1) technical success; (2) 30-day peri-operative major adverse events; (3) 30-day and midterm clinical success; (4) 30-day and midterm branch instability and TV-related adverse events (reinterventions, type I/III endoleaks).
Results: Sixty-eight patients (42 males; median age: 72 years) were treated through a TFA. All the centers included their entire experience with TFA: 18 (26%) used a homemade steerable sheath, and in 28 cases (41%), a stabilizing guidewire was employed. Steerable technical success was achieved in 66 patients (97%) with an overall in-hospital mortality of 6 patients (9%, 3 elective cases [3/58, 5%] and 3 urgent/emergent cases [3/12, 25%]) and major adverse event rate of 18% (12 patients). Overall, 257 bridging stents were implanted; of these, 225 (88%) were balloon-expandable and 32 (12%) were self-expanding. No strokes were observed among the patient completing the procedure from a TFA. One patient (2%) who failed to be treated completely from a TFA and needed a bailout UEA suffered an ischemic stroke on postoperative day 2. There were 10 (15%) major access-site complications. At 1-year follow-up, overall survival was 80%, and the rate of branch instability was 6%.
Conclusions: A TFA for TV cannulation is a safe and feasible option with high technical success preventing the stroke risk of UEA. Primary patency at midterm seems comparable to historical controls, and future larger studies will be needed to assess potential differences with alternative options.Clinical ImpactUsing a transfemoral approach for retrograde cannulation of reno-visceral branches is feasiable, safe and effective, thereby representing a reliable alternative for BEVAR interventions.
{"title":"Total Transfemoral Branched Endovascular Thoracoabdominal Aortic Repair (TORCH2): Short-term and 1-Year Outcomes From a National Multicenter Registry.","authors":"D'Oria Mario, Grandi Alessandro, Pratesi Giovanni, Parlani Gianbattista, Giudice Rocco, Gargiulo Mauro, Mangialardi Nicola, Chiesa Roberto, Lepidi Sandro, Bertoglio Luca","doi":"10.1177/15266028231179864","DOIUrl":"10.1177/15266028231179864","url":null,"abstract":"<p><strong>Objective: </strong>The use of steerable sheaths to allow total transfemoral access (TFA) of branched endovascular repair (BEVAR) of thoracoabdominal aortic aneurysms has been proposed as an alternative to upper extremity access (UEA); however, multicenter results from high-volume aortic centers are lacking.</p><p><strong>Materials and methods: </strong>The Total Transfemoral Branched Endovascular Thoracoabdominal Aortic Repair (TORCH2) study is a physician-initiated, national, multicenter, retrospective, observational registry (Clinicaltrials.gov identifier: NCT04930172) of patients undergoing BEVAR with a TFA for the cannulation of reno-visceral target vessels (TV). The study endpoints, classified according to Society for Vascular Surgery reporting standards, were (1) technical success; (2) 30-day peri-operative major adverse events; (3) 30-day and midterm clinical success; (4) 30-day and midterm branch instability and TV-related adverse events (reinterventions, type I/III endoleaks).</p><p><strong>Results: </strong>Sixty-eight patients (42 males; median age: 72 years) were treated through a TFA. All the centers included their entire experience with TFA: 18 (26%) used a homemade steerable sheath, and in 28 cases (41%), a stabilizing guidewire was employed. Steerable technical success was achieved in 66 patients (97%) with an overall in-hospital mortality of 6 patients (9%, 3 elective cases [3/58, 5%] and 3 urgent/emergent cases [3/12, 25%]) and major adverse event rate of 18% (12 patients). Overall, 257 bridging stents were implanted; of these, 225 (88%) were balloon-expandable and 32 (12%) were self-expanding. No strokes were observed among the patient completing the procedure from a TFA. One patient (2%) who failed to be treated completely from a TFA and needed a bailout UEA suffered an ischemic stroke on postoperative day 2. There were 10 (15%) major access-site complications. At 1-year follow-up, overall survival was 80%, and the rate of branch instability was 6%.</p><p><strong>Conclusions: </strong>A TFA for TV cannulation is a safe and feasible option with high technical success preventing the stroke risk of UEA. Primary patency at midterm seems comparable to historical controls, and future larger studies will be needed to assess potential differences with alternative options.Clinical ImpactUsing a transfemoral approach for retrograde cannulation of reno-visceral branches is feasiable, safe and effective, thereby representing a reliable alternative for BEVAR interventions.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"513-523"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-06-10DOI: 10.1177/15266028231179592
Johan Bondesson, Ga-Young Suh, Michael D Dake, Jason T Lee, Christopher P Cheng
<p><strong>Purpose: </strong>Type B aortic dissections propagate with either achiral (nonspiraling) or right-handed chiral (spiraling) morphology, have mobile dissection flaps, and are often treated with thoracic endovascular aortic repair (TEVAR). We aim to quantify cardiac-induced helical deformation of the true lumen of type B aortic dissections before and after TEVAR.</p><p><strong>Material and methods: </strong>Retrospective cardiac-gated computed tomography (CT) images before and after TEVAR of type B aortic dissections were used to construct systolic and diastolic 3-dimensional (3D) surface models, including true lumen, whole lumen (true+false lumens), and branch vessels. This was followed by extraction of true lumen helicity (helical angle, twist, and radius) and cross-sectional (area, circumference, and minor/major diameter ratio) metrics. Deformations between systole and diastole were quantified, and deformations between pre- and post-TEVAR were compared.</p><p><strong>Results: </strong>Eleven TEVAR patients (59.9±4.6 years) were included in this study. Pre-TEVAR, there were no significant cardiac-induced deformations of helical metrics; however, post-TEVAR, significant deformation was observed for the true lumen proximal angular position. Pre-TEVAR, cardiac-induced deformations of all cross-sectional metrics were significant; however, only area and circumference deformations remained significant post-TEVAR. There were no significant differences of pulsatile deformation from pre- to post-TEVAR. Variance of proximal angular position and cross-sectional circumference deformation decreased after TEVAR.</p><p><strong>Conclusion: </strong>Pre-TEVAR, type B aortic dissections did not exhibit significant helical cardiac-induced deformation, indicating that the true and false lumens move in unison (do not move with respect to each other). Post-TEVAR, true lumens exhibited significant cardiac-induced deformation of proximal angular position, suggesting that exclusion of the false lumen leads to greater rotational deformations of the true lumen and lack of true lumen major/minor deformation post-TEVAR means that the endograft promotes static circularity. Population variance of deformations is muted after TEVAR, and dissection acuity influences pulsatile deformation while pre-TEVAR chirality does not.Clinical ImpactDescription of thoracic aortic dissection helical morphology and dynamics, and understanding the impact of thoracic endovascular aortic repair (TEVAR) on dissection helicity, are important for improving endovascular treatment. These findings provide nuance to the complex shape and motion of the true and false lumens, enabling clinicians to better stratify dissection disease. The impact of TEVAR on dissection helicity provides a description of how treatment alters morphology and motion, and may provide clues for treatment durability. Finally, the helical component to endograft deformation is important to form comprehensive boundary condi
{"title":"Cardiac Pulsatile Helical Deformation of the Thoracic Aorta Before and After Thoracic Endovascular Aortic Repair of Type B Dissections.","authors":"Johan Bondesson, Ga-Young Suh, Michael D Dake, Jason T Lee, Christopher P Cheng","doi":"10.1177/15266028231179592","DOIUrl":"10.1177/15266028231179592","url":null,"abstract":"<p><strong>Purpose: </strong>Type B aortic dissections propagate with either achiral (nonspiraling) or right-handed chiral (spiraling) morphology, have mobile dissection flaps, and are often treated with thoracic endovascular aortic repair (TEVAR). We aim to quantify cardiac-induced helical deformation of the true lumen of type B aortic dissections before and after TEVAR.</p><p><strong>Material and methods: </strong>Retrospective cardiac-gated computed tomography (CT) images before and after TEVAR of type B aortic dissections were used to construct systolic and diastolic 3-dimensional (3D) surface models, including true lumen, whole lumen (true+false lumens), and branch vessels. This was followed by extraction of true lumen helicity (helical angle, twist, and radius) and cross-sectional (area, circumference, and minor/major diameter ratio) metrics. Deformations between systole and diastole were quantified, and deformations between pre- and post-TEVAR were compared.</p><p><strong>Results: </strong>Eleven TEVAR patients (59.9±4.6 years) were included in this study. Pre-TEVAR, there were no significant cardiac-induced deformations of helical metrics; however, post-TEVAR, significant deformation was observed for the true lumen proximal angular position. Pre-TEVAR, cardiac-induced deformations of all cross-sectional metrics were significant; however, only area and circumference deformations remained significant post-TEVAR. There were no significant differences of pulsatile deformation from pre- to post-TEVAR. Variance of proximal angular position and cross-sectional circumference deformation decreased after TEVAR.</p><p><strong>Conclusion: </strong>Pre-TEVAR, type B aortic dissections did not exhibit significant helical cardiac-induced deformation, indicating that the true and false lumens move in unison (do not move with respect to each other). Post-TEVAR, true lumens exhibited significant cardiac-induced deformation of proximal angular position, suggesting that exclusion of the false lumen leads to greater rotational deformations of the true lumen and lack of true lumen major/minor deformation post-TEVAR means that the endograft promotes static circularity. Population variance of deformations is muted after TEVAR, and dissection acuity influences pulsatile deformation while pre-TEVAR chirality does not.Clinical ImpactDescription of thoracic aortic dissection helical morphology and dynamics, and understanding the impact of thoracic endovascular aortic repair (TEVAR) on dissection helicity, are important for improving endovascular treatment. These findings provide nuance to the complex shape and motion of the true and false lumens, enabling clinicians to better stratify dissection disease. The impact of TEVAR on dissection helicity provides a description of how treatment alters morphology and motion, and may provide clues for treatment durability. Finally, the helical component to endograft deformation is important to form comprehensive boundary condi","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"332-341"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9732510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Endovascular aortic repair has become the preferred elective treatment of infrarenal aortic aneurysms. Aortic pulsatility may pose problems regarding endograft sizing. The aims of this study are to determine the aortic pulsatility in patients with aortic disease and to evaluate the effect of pulsatility on the growth of aneurysms.
Materials and methods: In this retrospective study, analyses of computed tomography angiography (CTA) images of 31 patients under conservative treatment for small abdominal aortic aneurysms were performed. Reconstructions of the raw electrocardiography (ECG) gated dataset at 30% and 90% of the R-R cycle were used. After lumen segmentation, total aortic cross-sectional area was measured in diastole and systole in the following zones: Z0, Z3, Z5, Z6, Z8, and Z9. Effective diameters (EDs) were calculated from the systolic (EDsys) and diastolic (EDdia) cross-sectional areas to determine absolute (EDsys - EDdia, mm) and relative pulsatility [(EDsys - EDdia) / EDdia, %]. Diameter of the aneurysms was measured on baseline images and the last preoperative follow-up study of each patient.
Results: A total of 806 measurements were completed, 24 pulsatility and 2 growth measurements per patient. The mean pulsatility values at each point were as follows: Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm. Follow-up time was 5.5±2.2 years during which a growth of 13.42±9.09 mm (2.54±1.55 mm yearly) was observed. No correlation was found between pulsatility values and growth rate of the aneurysms.
Conclusion: The pulsatility of the aorta is in a submillimetric range for the vast majority of patients with aortic disease, thus probably not relevant regarding endograft sizing. Pulsatility of the ascending aorta is smaller than that of the descending segment, making an additional oversize of a Z0 implantation questionable.Clinical ImpactEndovascular aortic repair reqiures precise preoperative planning. Pulsatile changes of the aortic diameter may pose issues regarding endograft sizing. In our retrospective single-centre study, aortic pulsatility of patients with AAA was measured on ECG gated CTA images. Pulsatility values reached a maximum at the descending aorta, however absolute pulsatility values did not exceed 1 mm at any point along the aorta. Therefore, significance of aortic pulsatility regarding the sizing of EVAR prostheses is questionable. Correlation between pulsatility and AAA growth was not found.
目的:血管内主动脉修复术已成为治疗肾下动脉瘤的首选方法。主动脉搏动可能会对移植物的大小造成影响。本研究的目的是确定主动脉疾病患者的主动脉搏动性，并评估搏动性对动脉瘤生长的影响。材料与方法:回顾性分析31例经保守治疗的小腹主动脉瘤的ct血管造影(CTA)图像。在R-R周期的30%和90%时，对原始心电图(ECG)门控数据集进行重建。管腔分割后，在Z0、Z3、Z5、Z6、Z8和Z9区域测量舒张期和收缩期主动脉总横截面积。根据收缩期(EDsys)和舒张期(EDdia)横截面积计算有效内径(EDs)，以确定绝对(EDsys - EDdia, mm)和相对脉搏度[(EDsys - EDdia) / EDdia， %]。根据基线图像和每位患者的最后一次术前随访研究测量动脉瘤的直径。结果:共完成806次测量，每例患者24次脉搏测量和2次生长测量。各点脉搏率平均值为:Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm。随访5.5±2.2年，平均生长13.42±9.09 mm(每年2.54±1.55 mm)。脉搏值与动脉瘤生长速率无相关性。结论:绝大多数主动脉疾病患者的主动脉搏动在亚毫米范围内，因此可能与移植物的大小无关。升主动脉的搏动比降主动脉的搏动小，这使得额外的过大的Z0植入是值得怀疑的。临床影响:血管内主动脉修复需要精确的术前计划。主动脉直径的搏动性改变可能会对移植物的大小造成影响。在我们的回顾性单中心研究中，通过心电图门控CTA图像测量AAA患者的主动脉搏动。在降主动脉处脉搏值最大，但沿主动脉任何一点的绝对脉搏值均不超过1mm。因此，主动脉搏动对EVAR假体尺寸的意义值得怀疑。脉搏与心房动脉生长无相关性。
{"title":"Pulsatile Changes of the Aortic Diameter May Be Irrelevant Regarding Endograft Sizing in Patients With Aortic Disease.","authors":"Daniele Mariastefano Fontanini, Máté Huber, Milán Vecsey-Nagy, Sarolta Borzsák, Judit Csőre, Péter Sótonyi, Csaba Csobay-Novák","doi":"10.1177/15266028231172368","DOIUrl":"10.1177/15266028231172368","url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular aortic repair has become the preferred elective treatment of infrarenal aortic aneurysms. Aortic pulsatility may pose problems regarding endograft sizing. The aims of this study are to determine the aortic pulsatility in patients with aortic disease and to evaluate the effect of pulsatility on the growth of aneurysms.</p><p><strong>Materials and methods: </strong>In this retrospective study, analyses of computed tomography angiography (CTA) images of 31 patients under conservative treatment for small abdominal aortic aneurysms were performed. Reconstructions of the raw electrocardiography (ECG) gated dataset at 30% and 90% of the R-R cycle were used. After lumen segmentation, total aortic cross-sectional area was measured in diastole and systole in the following zones: Z0, Z3, Z5, Z6, Z8, and Z9. Effective diameters (EDs) were calculated from the systolic (ED<sub>sys</sub>) and diastolic (ED<sub>dia</sub>) cross-sectional areas to determine absolute (ED<sub>sys</sub> - ED<sub>dia</sub>, mm) and relative pulsatility [(ED<sub>sys</sub> - ED<sub>dia</sub>) / ED<sub>dia</sub>, %]. Diameter of the aneurysms was measured on baseline images and the last preoperative follow-up study of each patient.</p><p><strong>Results: </strong>A total of 806 measurements were completed, 24 pulsatility and 2 growth measurements per patient. The mean pulsatility values at each point were as follows: Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm. Follow-up time was 5.5±2.2 years during which a growth of 13.42±9.09 mm (2.54±1.55 mm yearly) was observed. No correlation was found between pulsatility values and growth rate of the aneurysms.</p><p><strong>Conclusion: </strong>The pulsatility of the aorta is in a submillimetric range for the vast majority of patients with aortic disease, thus probably not relevant regarding endograft sizing. Pulsatility of the ascending aorta is smaller than that of the descending segment, making an additional oversize of a Z0 implantation questionable.Clinical ImpactEndovascular aortic repair reqiures precise preoperative planning. Pulsatile changes of the aortic diameter may pose issues regarding endograft sizing. In our retrospective single-centre study, aortic pulsatility of patients with AAA was measured on ECG gated CTA images. Pulsatility values reached a maximum at the descending aorta, however absolute pulsatility values did not exceed 1 mm at any point along the aorta. Therefore, significance of aortic pulsatility regarding the sizing of EVAR prostheses is questionable. Correlation between pulsatility and AAA growth was not found.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"398-403"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9431870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Purpose: </strong>Endovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. In this study, we investigated the prevalence and severity of HBR, as well as its association with clinical outcomes in the patients with PAD who underwent EVT.</p><p><strong>Materials and methods: </strong>The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were applied to 732 consecutive patients with lower extremity PAD post-EVT to assess the prevalence of HBR, and its association with major bleeding events, all-cause mortality, and ischemic events. The ARC-HBR scores (1 point for each major criterion and 0.5 points for each minor criterion) were obtained and the patients were divided into four groups (score: 0-0.5; low risk, score: 1-1.5; moderate risk, score: 2-2.5; high risk, and score: ≥3; very high risk) according to the score. Major bleeding events were defined as Bleeding Academic Research Consortium type-3 or type-5 bleeding, and ischemic events were defined as the composite of myocardial infarction, ischemic stroke, and acute limb ischemia within 2 years.</p><p><strong>Results: </strong>High bleeding risk occurred in 78.8% of the patients. Major bleeding events, all-cause mortality, and ischemic events occurred in 9.7%, 18.7%, and 6.4% of the study cohort, respectively, within 2 years. During the follow-up period, major bleeding events significantly increased with the ARC-HBR score. The severity of the ARC-HBR score was significantly associated with an increased risk of major bleeding events (high risk: adjusted hazard ratio [HR] 5.62; 95% confidence interval [CI]: [1.28, 24.62]; p=0.022; very high risk: adjusted HR: 10.37; 95% CI: [2.32, 46.30]; p=0.002). All-cause mortality and ischemic events also significantly increased with higher ARC-HBR score.</p><p><strong>Conclusions: </strong>High bleeding risk patients with lower extremity PAD can be at a high risk of bleeding events, mortality, and ischemic events after EVT. The ARC-HBR criteria and its associated scores can successfully stratify HBR patients and assess the bleeding risk in patients with lower extremity PAD who undergo EVT.Clinical ImpactEndovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. Post EVT, most of the patients with PAD were classified as having HBR using the Academic Research Consortium for HBR (ARC-HBR) criteria and the rate of bleeding events as well as mortality and ischemic events within 2 years increased as the ARC-HBR score increased in this retrospective study of 732 participants. HBR patients with PAD can be at hig
{"title":"Clinical Outcomes Based on High Bleeding Risk in Patients With Lower Extremity Peripheral Artery Disease Who Have Undergone Endovascular Therapy.","authors":"Naoki Yoshioka, Takahiro Tokuda, Akio Koyama, Takehiro Yamada, Kiyotaka Shimamura, Ryusuke Nishikawa, Yasuhiro Morita, Itsuro Morishima","doi":"10.1177/15266028231176953","DOIUrl":"10.1177/15266028231176953","url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. In this study, we investigated the prevalence and severity of HBR, as well as its association with clinical outcomes in the patients with PAD who underwent EVT.</p><p><strong>Materials and methods: </strong>The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were applied to 732 consecutive patients with lower extremity PAD post-EVT to assess the prevalence of HBR, and its association with major bleeding events, all-cause mortality, and ischemic events. The ARC-HBR scores (1 point for each major criterion and 0.5 points for each minor criterion) were obtained and the patients were divided into four groups (score: 0-0.5; low risk, score: 1-1.5; moderate risk, score: 2-2.5; high risk, and score: ≥3; very high risk) according to the score. Major bleeding events were defined as Bleeding Academic Research Consortium type-3 or type-5 bleeding, and ischemic events were defined as the composite of myocardial infarction, ischemic stroke, and acute limb ischemia within 2 years.</p><p><strong>Results: </strong>High bleeding risk occurred in 78.8% of the patients. Major bleeding events, all-cause mortality, and ischemic events occurred in 9.7%, 18.7%, and 6.4% of the study cohort, respectively, within 2 years. During the follow-up period, major bleeding events significantly increased with the ARC-HBR score. The severity of the ARC-HBR score was significantly associated with an increased risk of major bleeding events (high risk: adjusted hazard ratio [HR] 5.62; 95% confidence interval [CI]: [1.28, 24.62]; p=0.022; very high risk: adjusted HR: 10.37; 95% CI: [2.32, 46.30]; p=0.002). All-cause mortality and ischemic events also significantly increased with higher ARC-HBR score.</p><p><strong>Conclusions: </strong>High bleeding risk patients with lower extremity PAD can be at a high risk of bleeding events, mortality, and ischemic events after EVT. The ARC-HBR criteria and its associated scores can successfully stratify HBR patients and assess the bleeding risk in patients with lower extremity PAD who undergo EVT.Clinical ImpactEndovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. Post EVT, most of the patients with PAD were classified as having HBR using the Academic Research Consortium for HBR (ARC-HBR) criteria and the rate of bleeding events as well as mortality and ischemic events within 2 years increased as the ARC-HBR score increased in this retrospective study of 732 participants. HBR patients with PAD can be at hig","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"439-451"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9538352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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