Journal of Endovascular Therapy最新文献

Purpose: Clinical trials have demonstrated that high-dose drug-coated balloon (HD-DCB) and polymer-based drug-eluting stent (PB-DES) treatments for femoropopliteal (FP) artery disease have favorable outcomes. However, which one would be better remained unrevealed.

Methods: This study used the databases of 2 large-scale multicenter prospective drug-coated balloon (DCB) and drug-eluting stent (DES) registries. The study included 2470 patients with symptomatic FP lesion treated with IN.PACT Admiral DCB or Eluvia DES at 69 centers. A propensity-score-based paired analysis was conducted. Primary endpoint was 1-year restenosis rate. Secondary endpoints were 1-year reocclusion rate, target lesion revascularization (TLR), acute thrombosis, bypass conversion, major amputation, major adverse limb event (MALE), and all-cause death.

Results: A total of 1535 patients were treated with HD-DCB, and 935 patients were treated with PB-DES. The propensity-score matching extracted 678 pairs, with no remarkable intergroup difference in baseline characteristics. The 1-year restenosis rate was significantly lower in the PB-DES group than in the HD-DCB group (16.0% vs 22.0%, p=0.016). The other endpoints (reocclusion rate, TLR, acute thrombosis, bypass conversion, major amputation, MALE, and all-cause death) did not differ between the groups. No baseline characteristics had any significant interaction effect on the association of HD-DCB vs PB-DES with restenosis risk (all p>0.05).

Conclusions: This study demonstrated that the 1-year TLR, reocclusion rate, and other endpoints did not differ between the PB-DES group and the HD-DCB group despite the lower restenosis in the PB-DES group.Clinical ImpactOne-year restenosis rate was significantly lower in the polymer-based DES group than in the high-dose DCB group for foemoropopliteal disease. However, there is no difference in the other endpoints between two groups.

Background: Complex endovascular repair with fenestrated or branched stent grafts is a common approach for treating various types of aortic aneurysms. Bridging stent grafts (BSs) are crucial in connecting aortic endoprosthesis to target vessels, yet current options have demonstrated significant complications.

Objective: This retrospective single-center study evaluates the initial outcomes and durability of the iCover stent graft (iCover-SG) when used as a BS in fenestrated endovascular aneurysm repair (FEVAR).

Methods: Retrospective analysis screened procedures for complex aortic aneurysms between August 2021 and January 2024. Patients who underwent FEVAR with iCover-SG as BS were included. Primary and secondary endpoints focused on freedom from iCover-SG-related target vessel instability, technical success, and postoperative outcomes.

Results: Within the cohort of 28 patients, 94 iCover-SGs were used as BS, supplying 87 target vessels. The freedom from iCover-SG-related target vessel instability throughout the study reached 94% (82/87). Technical success rates were notably high, with primary success achieved in 94% of cases and secondary success in 99%. Over the follow-up duration, there were instances necessitating reintervention related to iCover-SG, including 4 cases of endoleak, 2 cases of T1cEL, and 2 cases of T3cEL. In-hospital mortality was 7% (n=4), with 2 cases attributed to intraoperative complications. Importantly, no deaths were directly attributed to iCover-SG-related issues.

Conclusion: The iCover-SG demonstrates promising initial outcomes as a BS in FEVAR, with high technical success rates and satisfactory rates of target vessel instability. Continued monitoring and further studies are warranted to assess long-term durability and outcomes.Clinical ImpactThis study shows that the iCover stent graft achieves satisfactory technical success and target vessel stability in the short- and mid-term when used as a bridging stent graft in FEVAR procedures. Its successful integration into clinical practice broadens the range of available options, providing clinicians with more versatile tools for managing complex endovascular aortic aneurysms. This expanded selection of bridging stent grafts allows for more personalised treatment strategies, improving procedural precision and patient outcomes. The iCover stent graft's reliable performance highlights its potential as a valuable addition to current endovascular techniques, ultimately enhancing patient care in challenging cases.

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity, mortality, and elevated healthcare costs. Between 20% and 50% of patients with lower extremity deep vein thrombosis will develop an advanced complication called post-thrombotic syndrome (PTS) within 2 years. Early mortality rates for DVT and acute high-risk pulmonary embolism are 3.8% and 38.9%, respectively. Additionally, PE is the most common and preventable cause of in-hospital death. Early removal of thrombus and improvement of vascular function can reduce the incidence of serious complications and mortality. Catheter-directed thrombolysis (CDT) involves the placement of a thrombolytic catheter into a venous thrombus, allowing the thrombolytic drug to act directly on the thrombus. Compared to conventional anticoagulation, CDT removes thrombus more rapidly, thereby enhancing venous function in the lower extremities and reducing pulmonary artery pressure. Compared to systemic thrombolytic therapy, CDT is safer, and complications from the procedure are uncommon. However, the risk of bleeding is slightly higher with CDT than with anticoagulation alone. In this review, we will discuss the pathophysiology of VTE and the technical advancements in CDT. We will also examine a selection of notable studies on CDT for the treatment of DVT in the lower extremities and PE in recent years, with the aim of integrating the findings.Clinical ImpactCatheter-directed thrombolysis reduces the thrombolytic time and dose of thrombolytic drugs without affecting the thrombolytic effect to ensure that bleeding does not occur. This helps clinicians choose safer CDT treatments for their patients. We combine the historical process of catheter-directed thrombolytic therapy for VTE and prospect the future development of CDT.

Background: A vascular closure device (VCD) may be employed to close arteriotomy of the femoral artery following endovascular surgery, catheterization, and extracorporeal life support cannulation. Such devices aim to reduce the time to hemostasis and avoid the need for manual compression. Despite ubiquity of VCDs in clinical practice, limited research on the hemodynamic impact of these devices has been published.

Methodology: Four commonly-used VCDs were applied on a 10 mm longitudinal incision in a 3/8 inch diameter polyvinylchloride tubing for geometry. Each sample was imaged with micro-computed tomography and reconstructed into a 3-dimensional model. Using computational fluid dynamics, blood flow over the 4 VCDs was simulated in a straight cylinder. In addition, 1 sample was simulated in a patient-specific femoral artery geometry. Time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and endothelial cell activation potential were used to assess the impact of each device on vessel hemodynamics.

Results and conclusions: The results suggest that anchor-based devices, resulted in larger flow disturbances, decreasing TAWSS and increasing OSI in their wake, compared with suture-based devices. Such conditions are likely to be pro-thrombotic. While the choice of VCD may be multifactorial, the present study offers new comparative data on their hemodynamic impact.Clinical ImpactThe results from the present study offer unique comparative data on the hemodynamic impact of 4 vascular closure devices. These findings may help in the selection of devices. The pro-thrombotic nature of anchor-based devices may make these less suitable for certain clinical scenarios where there is a high risk of thrombosis and vessel occlusion.

Purpose: Active fixation thoracic endografts have been presumed to cause adverse events in patients with aortic syndromes. This study evaluated the outcomes of a barb-fixated thoracic endograft and compared with a non-actively fixated endograft in patients managed for aortic syndromes.

Materials and methods: A single center retrospective analysis was conducted using the STROBE guidelines. Patients treated for aortic syndromes with the barb-fixated Zenith TX2 TAA Endovascular Graft (ZTEG) between January 2011 and June 2024 were included. Patients with replaced proximal landing zones and genetic aortic syndromes were excluded. Primary outcomes were migration and migration distance (MD) in patients with at least 12 months of follow-up. A propensity-score matched comparison (1:1) to patients treated with the non-active fixation Zenith TX2 Dissection Endovascular Graft (ZDEG) was performed, after applying the same eligibility criteria.

Results: Ninety-six patients treated with ZTEG were included. No perioperative retrograde type A aortic dissection (rTAAD) or intramural hematoma occurred. Both endoleak Ia and proximal reintervention rates were 6%, each, at 20 months (IQR, 1-54.5). Endograft migration was assessed in 65 patients [median (IQR) follow-up: 33 months (IQR 20-71)], showing a 2 and 20% migration at 1 year and maximum follow-up, respectively, with a median MD of 2 mm (IQR 0-5) and 5 mm (IQR 2-9) at the same timepoints, respectively. The propensity score-matched comparison with 23 ZDEG patients revealed significantly lower 1-year migration (4% vs 35%; p=0.04) and shorter median MD [4 mm (IQR 0-9.5) vs 10 mm (IQR 6-15.5); p=0.016] at maximum follow-up for the ZTEG group. No difference was observed in endoleak Ia, proximal reintervention, or rTAAD rates at any point.

Conclusion: The use of barb-mediated fixation ZTEG endograft in patients with aortic syndromes demonstrated reduced migration and MD compared with the non-actively fixated ZDEG, without differences in rTAAD, endoleak Ia, or proximal reintervention during follow-up.Clinical ImpactThoracic endovascular aortic repair with a barb-fixated endograft (Zenith TX2 TAA Endovascular Graft; ZTEG) in patients with aortic syndromes demonstrated migration rates of 2% at 1 year and 20% at maximum follow-up, with no retrograde dissection (rTAAD). In a propensity score-matched comparison with a non-active fixation endograft (Zenith TX2 Dissection Endovascular Graft; ZDEG), ZTEG showed significantly lower 1-year migration and shorter migration distance at maximum follow-up. No difference was observed in endoleak Ia, proximal reintervention, or rTAAD at any time point. These findings suggest that ZTEG may reduce distal migration without compromising safety regarding retrograde dissection, contrary to existing concerns.

Introduction: A consensus exists among vascular surgery societies that blunt thoracic aortic injury (BTAI) should be treated with thoracic endovascular aortic repair (TEVAR) in patients with favorable aortic anatomy. However, selecting the correct landing zones and endograft sizing remains challenging in patients with BTAI. To overcome these limitations, conformable endografts are often used for TEVAR, even in patients with BTAI. This study aimed to analyze the outcomes of these patients with respect to anatomical and technical factors.

Methods: This retrospective study included all patients with BTAI who underwent TEVAR at a tertiary vascular center. The primary endpoint was aortic-related reintervention-free survival. Secondary endpoints were 30-day in-hospital mortality, postoperative complications, and radiological findings. Patients were divided into 2 groups: group 1, patients with a conformable endograft (cTAG Gore), and group 2, patients with a nonconformable endograft.

Results: Between June 2001 and May 2019, 57 patients (50 men; mean age, 37.3 years) with BTAI received 30 (52.6%) conformable (Gore cTAG) and 27 (47.4%) nonconformable endografts. The 1-, 3-, and 5-year aortic-related reintervention-free survival was 100%, 100%, and 96.7% in group 1 and 81.4%, 81.4%, and 77.7% in group 2, respectively (p=0.03). Two postoperative type Ia endoleaks and 3 postoperative type II endoleaks were observed in group 2. The bird beak sign was noted more often in group 2 (70.4% vs 53.3, p=0.32).

Conclusions: This study, in a small cohort of patients, demonstrated that the Gore cTAG, when properly selected according to the patient's anatomy, appears to provide better outcomes after TEVAR for patients with BTAI than nonconformable devices. A bird beak sign occurred frequently in both groups and were not associated with poor outcomes. Further studies are required to confirm these findings.Clinical ImpactThis study in a small cohort of patients demonstrated that the Gore cTAG endoprosthesis, when properly selected to match the patient's anatomy, appears to result in better outcomes after TEVAR in patients with BTAI than nonconformable devices. In addition, the BBS was common in both groups of patients and was not associated with a worse outcome.

Introduction: Injuries of the inferior vena cava (IVC) secondary to blunt trauma is a rare life-threatening condition that has a mortality rate up to 70%. Prompt diagnosis and treatment is mandatory. Endografts are commonly used in arterial trauma, but their use in veins injury is rarely reported in literature.

Case report: We report a case of a 72-year-old foreign woman with IVC injuries at confluence treated in an emergency setting. She arrived at the emergency room after a car crash. Computed tomography (CT) angiography showed rupture of iliocaval confluence with massive active bleeding. Endovascular repair was promptly performed using an aortic unibody stent graft to achieve bleeding control. One month CT angiography showed patency of the endograft and of both iliac veins, and no evidence of thrombotic apposition.

Conclusion: Inferior vena cava injury has high mortality rate, and this novel approach may allow iliocaval repair in a successful and rapid manner. Moreover, the unibody endograft is suitable for reconstructing the IVC and both iliac veins simultaneously, showing great adaptability to the venous system.Clinical ImpactThis case suggests a new, although experimental, path for addressing severe venous traumas. The innovation lies in demonstrating that an "off-label" unibody aortic endograft can provide a minimally invasive option for highly complex ilio-caval confluence ruptures, where few other solution exist, potentially improving outcomes in these challenging scenarios.