Journal of Endovascular Therapy最新文献

Introduction: Thoracic endovascular aortic repair (TEVAR) in chronic dissection is associated with a risk for distal stent-graft-induced new entry (dSINE) in up to a quarter of cases. We assess the mid-term outcome of a novel dissection-specific stent-graft (DSSG), which is a custom-made device based on the Cook Alpha platform, with a modified graft design and a distal endovascular elephant trunk without any supporting stent to reduce the radial force on the dissection membrane at the distal landing zone.

Methods: A retrospective single-center study of chronic dissection patients at high risk of dSINE who received an elective endovascular repair with DSSG from January 2017 to June 2023. The primary outcome is Kaplan-Meier (KM) estimated freedom from dSINE during follow-up. Secondary outcomes included technical success, aortic remodeling, and anatomical evaluation of the distal landing zone in cases with dSINE during follow-up versus those without.

Results: Thirty patients (24 males) with a median age of 66 years [range=31-78] underwent elective TEVAR with the DSSG. The majority, n=27 (90%), had previous aortic repair; 7 (23%) had established connective tissue disease, and 6 (20%) had established dSINE after previous stent-graft implantation as an indication for TEVAR. Technical success was achieved in n=29 (97%). Median follow-up was 38.5 months (4.3-76.4), and KM estimated freedom from dSINE at 1 and 3 years was 95.6% (SE 0.043) and 89% (SE 0.081), respectively Four cases developed dSINE during follow-up. The median distance from the distal stent-graft to the coeliac trunk was 74mm (range=18-123) in the dSINE group versus 26mm (range=0-74) in the non-dSINE group (p=0.049). Median proximal tangential aortic angulation in the distal landing zone was 38.5° (range=26°-50°) in the dSINE group compared to 21° (range=3-61°) in the non-dSINE group (p=0.052).

Conclusions: The Use of a novel DSSG with low radial force for TEVAR in the setting of chronic dissection is safe and feasible, with remodeling outcomes comparable with standard TEVAR. The reduced distal radial force in the DSSG does not eliminate the risk for dSINE over time, with new entries occurring, particularly in cases where the distal landing zone is in a tortuous aortic segment and not close to the coeliac trunk.Clinical ImpactUsing the novel dissection-specific stent-graft with reduced radial force is safe and feasible but does not completely eliminate the risk of dSINE occurring over time. The exact positioning of the distal stent-graft in a straight aortic segment, close to the coeliac trunk, may be of importance to further mitigate the risk.

Purpose: To describe a standardized technique for managing "wire wrap" during the implantation of fenestrated endografts in the aortic arch. This approach aims to enhance wire position predictability, reduce unnecessary device manipulations, and improve procedural safety in fenestrated thoracic endovascular aortic repair (f-TEVAR).

Technique: The technique is illustrated through 3 representative cases, including a customized triple-wide scallop endograft with a single fenestration featuring a preloaded guidewire, as well as 2 additional physician-modified endograft cases. The procedure begins with detailed preoperative imaging to plan graft selection and positioning. A through-and-through wire system is employed, with careful advancement of the delivery system into the descending thoracic aorta. We distinguish 3 possible scenarios in right anterior oblique fluoroscopy regarding wire position: guidewire aligned, graft positioned posterior to the wire, or graft positioned anterior to the wire. Specific rotational maneuvers-clockwise or counterclockwise-are performed in the descending thoracic aorta to resolve wire wrapping. Once corrected, the fenestration aligns precisely with the targeted supra-aortic branch for graft deployment.

Conclusion: The systematic approach to addressing "wire wrap" during f-TEVAR minimizes embolization and device distortion risks while optimizing procedural efficiency. This reproducible technique provides a valuable tool for advancing endovascular repair in challenging aortic arch pathologies.Clinical ImpactThis standardized technique for managing "wire wrap" during fenestrated thoracic endovascular aortic repair provides a reproducible and practical approach to a well-recognized intraoperative challenge. By systematizing wire handling, the technique enhances procedural safety and minimizes unplanned maneuvers that may increase operative time and radiation exposure while also facilitating device alignment and deployment in demanding scenarios. The innovation lies in offering a simple, easily adoptable strategy that can be consistently applied across operators and centers, supporting safer dissemination of complex endovascular techniques and promoting more predictable outcomes in advanced aortic repair.

Persistent sciatic artery (PSA) is a rare congenital vascular abnormality associated with the embryonic development of the iliac, common femoral, and superficial femoral arteries. Most cases of PSA are incidentally detected and are generally asymptomatic. However, PSA can present as chronic pain, such as neuralgia from aneurysmal dilatation compressing the sciatic nerve, or ischemic pain due to thrombus embolization from the aneurysm. In severe cases, aneurysm rupture poses a significant threat to both limb and life. Timely detection and appropriate intervention are therefore crucial. This article explores the clinical characteristics and treatment strategies of PSA, exemplified through the management of a patient with PSA complicated by distal embolization.Clinical ImpactThis study underscores the importance of simultaneously addressing both the aneurysm and distal thromboembolism in symptomatic persistent sciatic artery (PSA) cases, rather than treating embolic events alone. It reinforces endovascular repair as a preferred, minimally invasive strategy, reducing surgical trauma and nerve injury risk. For clinicians, this highlights the need for vigilant follow-up and consideration of early combined intervention to prevent recurrence. The innovation lies in demonstrating the efficacy of a staged, hybrid endovascular approach and proposing postural modification as a potential adjunct to slow aneurysm progression, offering a refined management paradigm for this rare condition.

Introduction: Endovascular repair of the aortic arch has emerged as an alternative to open surgery, particularly for high-risk and elderly patients. While multibranched endografts have demonstrated technical success, anatomical suitability remains a key limiting factor, especially given the variability of arch anatomy. The aim of the present study is to evaluate the suitability of the Hector multibranch device in a cohort of patients who underwent endovascular treatment for aortic arch's lesions.

Methods: A total of 539 patients were treated between 1999 and 2024, with 79 included in a single-center, retrospective, preclinical study. The suitability for device and its connecting stent was defined according to the manufacturer's instructions for use. Extended suitability was also evaluated, including patients excluded for limiting anatomical criteria. Secondary outcomes were suitable and non-suitable patients' comparison, exclusion causes analysis, and anatomical characteristics associated with suitability. A logistic regression model assessed associations between baseline and non-suitability.

Results: A total of 50 patients (63.2%) were suitable for implantation, raising to 54 (68.4%) by using other available bridging stents. Approximately half of the eligible patients could have been treated using 14 configurations for the analyzed device. The left common carotid artery bridging stent was appropriate for all suitable patients, while the appropriateness rate for the left subclavian artery stent was 92.6%. The odds of non-feasibility increased with proximal landing zone shortening (OR=1.05, p=0.015), whereas each additional millimeter in BCT length increased the odds of suitability by 6% (OR=1.06, p=0.046).

Conclusions: The Hector Stent Graft system coupled with commercially available bridging stents for supra-aortic trunks proved to be feasible for more than two-thirds of patients previously subjected to an endovascular treatment for aortic arch pathologies. The left common carotid artery bridging stent was suitable for all patients, while the one for the left subclavian artery was adequate for 9 out of 10 cases.Clinical ImpactThe Hector™ Stent Graft system shows high anatomical feasibility for endovascular aortic arch repair, with broad applicability using limited configurations. Its design may help minimize supra-aortic-trunks manipulation and facilitate safer, more streamlined procedures to treat the aortic arch pathologies in a complete endovascular fashion.

Background: Endovascular aneurysm repair (EVAR) has become a standard treatment for abdominal aortic aneurysms. However, the evolution of EVAR research and its global landscape remain underexplored. This bibliometric analysis aims to map publication trends, identify key contributors, and analyze thematic shifts in EVAR literature over the past three decades.

Methods: Data were collected from the Web of Science Core Collection (SCIE) in May 2025. A total of 4264 original research articles on EVAR were analyzed using VOSviewer for co-authorship, co-citation, and keyword co-occurrence mapping. Citation trends, geographical distribution, and institutional contributions were also assessed.

Results: Research on EVAR showed steady growth, with a peak of 295 publications in 2024. The United States contributed the largest share (33.02%) of publications. Prolific authors such as Schermerhorn and Verhagen, affiliated with leading institutions like Harvard University, played a pivotal role in advancing the field. Keyword analysis revealed a shift from technical terms (e.g., "stent graft") to clinical outcomes (e.g., "reintervention") over time. The integration of artificial intelligence (AI) in EVAR research is emerging as a key focus area.

Conclusion: This study highlights the growth and evolving focus of EVAR research, with a notable shift toward patient-centered outcomes. Despite strong contributions from high-income countries, there is a significant gap in research from low-resource settings. Future directions should include addressing gaps in radiation safety, emergency EVAR applications, and exploring AI-driven clinical decision-making for personalized treatments. Complex EVAR research continues expanding, reflecting guideline evolution and advancing practice in anatomically challenging cases.Clinical ImpactThis bibliometric analysis demonstrates how EVAR has progressed from an emerging minimally invasive technique to a guideline driven standard of care, with a growing emphasis on complex fenestrated and branched procedures. For clinicians, the findings clarify where the evidence base is well established, particularly for standard infrarenal EVAR, and where further caution and innovation are required, including complex anatomies, long term durability, and reintervention risk. By synthesizing influential studies, key guideline milestones, and evolving research themes, this study supports evidence based clinical decision making, improves patient counseling, and reinforces the importance of lifelong surveillance. Its innovation lies in translating three decades of global research into clinically actionable insight.

Background: Fibrosing mediastinitis is a rare critical disease that encases and compresses mediastinal structures. It is classified as either primary (idiopathic) or secondary based on the underlying etiology. Idiopathic fibrosing mediastinitis presents significant diagnostic challenges, particularly when patients presented with nonspecific symptoms, which may result in misdiagnosis.

Case report: A 53-year-old male patient with bilateral pulmonary artery stenosis due to idiopathic fibrosing mediastinitis was successfully treated with balloon angioplasty and bilateral stent implantation. Subsequent follow-up visits over 3 years demonstrated sustained improvement in the patient's symptoms. Imaging studies confirmed the complete patency of the implanted stents, with no evidence of vascular defects or in-stent restenosis.

Conclusion: Achieving an accurate diagnosis is critical in these cases; furthermore, transcatheter stent implantation is an effective intervention for managing vascular stenosis associated with fibrosing mediastinitis.Clinical ImpactThe rarity of idiopathic fibrosing mediastinitis and the lack of evidence-based treatment strategies make the diagnosis and management challenging. This case emphasizes the importance of endovascular intervention and underscores its role as a viable treatment option for managing similar cases of pulmonary artery stenosis due to fibrosing mediastinitis.

Background: Perirectal vascular malformations are uncommon and difficult lesions due to their deep location and proximity to vital pelvic structures. Traditional treatments include endoscopic, percutaneous, or surgical methods, each with potential risks. We aim to describe a novel, minimally invasive transperineal approach technique for treating perirectal venous and lymphatic malformations using combined polidocanol and bleomycin sclerotherapy.

Methods: Three patients with perirectal vascular malformations were treated using a transrectal digital-guided (finger) approach under fluoroscopic control. After lesion mapping with ionic or non-ionic contrast, sclerotherapy was performed using polidocanol-based foam combined with bleomycin.

Results: All procedures were technically successful. The approach allowed accurate localization, safe puncture, and effective sclerosis of the lesions while reducing procedural trauma. Postoperative pain was mild and self-limited. No cases of systemic toxicity, deep venous thrombosis, or tissue necrosis were observed during follow-up.

Conclusion: The transperineal approach provides a safe and effective alternative for treating perirectal vascular malformations, offering excellent anatomic control and reduced morbidity. Combined polidocanol-bleomycin sclerotherapy appears to be a feasible and well-tolerated therapeutic option; however, larger studies are needed to confirm its efficacy and long-term outcomes.Clinical ImpactThe transperineal approach for the management of slow-flow vascular malformations represents a practical, safe, and reproducible therapeutic option that provides minimally invasive access to complex perirectal lesions. By eliminating the need for endoscopic instruments or major surgical procedures, it reduces both procedural risks and associated costs. Its technical simplicity and minimal equipment requirements facilitate its implementation in most vascular centers, broadening access to specialized care across various clinical settings.

Objective: This study aimed to assess the current status of radiation safety training, practices, and exposure awareness among vascular surgery trainees and consultants across Spain.

Methods: This was a national cross-sectional survey. An anonymous online questionnaire was distributed to all members of the Spanish Society of Angiology and Vascular Surgery. The survey collected data on professional status (trainee or consultant), years of training or practice, formal radiation protection education, feedback on exposure levels, use of personal protective equipment, and adherence to As Low As Reasonably Achievable (ALARA) principles. All responses were recorded electronically and analyzed using descriptive statistics.

Results: Ninety participants completed the survey, including 21 trainees (23.3%) and 69 consultants (76.7%). Among them, 94.1% of trainees and 75% of consultants reported receiving formal radiation safety training during residency. However, only 15.8% of trainees and 44.9% of consultants had completed an updated radiation protection course. Regarding routine feedback on occupational exposure, 38.1% of trainees and 72.5% of consultants reported receiving regular updates. Advanced protective measures were underused. None of the trainees and 4.4% of consultant members reported exceeding the annual dose limit of 20 mSv.

Conclusion: Our findings provide relevant information on radiation safety practices among vascular surgery professionals in Spain. A significant proportion of both trainees and consultants lack regular exposure feedback and have limited interaction with radiation safety personnel. In addition, many have not received recent refresher training. These results support the need for structured education, consistent exposure monitoring, and reinforcement of safety protocols across all levels of surgical training.Clinical ImpactThis nationwide survey provides a national overview of radiation safety training, monitoring, and protective practices among vascular surgery trainees and consultants in Spain. It shows that, despite widespread use of basic protective equipment, relevant gaps persist in refresher education, exposure feedback, and the implementation of advanced ALARA strategies. For clinicians, these findings underscore the need to move beyond individual protective measures toward structured, institutionally supported radiation safety practices. This study represents the first national evidence in Spain to support standardized training programs, institutional radiation safety protocols, and policies to reduce long-term occupational radiation exposure.