Journal of Endovascular Therapy最新文献

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.

Background: Distal aortic expansion (DAE) after thoracic endovascular aortic repair (TEVAR) remains a critical long-term outcome-related determinant. The aim of this study was to identify risk factors for postoperative DAE through a meta-analysis and meta-regression.

Methods: In this systematic review and meta-analysis, the PubMed, Embase, and the Cochrane Library databases were searched from database inception to April 1, 2025. The primary outcome was the incidence of distal aortic expansion (DAE) after TEVAR. Pooled effect estimates were calculated using random-effects models, and heterogeneity was assessed with Cochran's Q test and the I² statistic. Meta-regression was performed to explore potential predictors of DAE. Publication bias was evaluated using Egger's test and funnel plots.

Results: Twenty-four studies were included, with a pooled DAE incidence of 27% (95% CI: 21%-35%). Meta-regression indicated that male sex (RR = 3.00, p=0.020), myocardial infarction (RR = 5.98, p<0.001), peripheral vascular disease (RR = 3.39, p=0.007), malperfusion (RR = 1.52, p=0.050), and postoperative false lumen expansion (RR = 1.18, p=0.046) were associated with increased DAE risk. Older age, prior cardiac surgery, congestive heart failure, residual dissection, and post-false lumen (FL) complete thrombosis (distal) were protective factors.

Conclusions: DAE after TEVAR is determined by a combination of patient comorbidities and aortic remodeling features. Identifying high-risk profiles-such as male sex, cardiovascular comorbidities, and persistent false lumen-may help optimize surveillance and reduce late aortic complications.Clinical ImpactDistal aortic expansion (DAE) remains a major determinant of late failure after TEVAR for type B aortic dissection. This study provides a comprehensive quantitative synthesis of clinical and remodeling-related predictors of DAE, highlighting high-risk profiles such as male sex, hypertension, prior myocardial infarction, peripheral vascular disease, and persistent false lumen patency. By integrating demographic, comorbidity, and morphological factors, the findings support a risk-adapted surveillance strategy rather than uniform follow-up protocols. Importantly, the study underscores the prognostic significance of false lumen dynamics, reinforcing the role of adjunctive techniques aimed at promoting distal thrombosis. These insights may facilitate individualized monitoring, earlier intervention, and improved long-term durability after TEVAR.

Purpose: Infrapopliteal arterial disease represents a complex subtype of peripheral artery disease (PAD). This study aimed to develop an interpretable machine learning model to assess the severity of infrapopliteal artery lesions.

Methods: Clinical data from patients with PAD treated at our institution were obtained between July 2019 and October 2024. Based on the angiographic results, patients were categorized into a mild lesion group (n=584) and a severe lesion group (n=478). Data from 2019 to 2023 were used for model development, with 70% allocated to the training set and 30% to the validation set. Clinical data from patients in 2024 served as the external test set. Feature selection was performed using 3 distinct machine learning algorithms. Subsequently, 10 different predictive models were developed and compared. The optimal model was interpreted and deployed. Finally, we conducted subgroup analyses.

Results: A total of 1062 patients were included in the study. Six predictors were identified through feature selection and used for model construction. Among the 10 models, the Gradient Boosting Machine (GBM) demonstrated the best predictive performance, achieving area under the curve (AUC) values of 0.891 in the validation set, indicating high discriminative ability. The calibration curve showed good agreement with the ideal line. Decision curve analysis demonstrated that the model provided superior net benefit within a threshold probability range of approximately 15% to 90%. Model interpretation was performed using Shapley additive explanations. Additionally, a nomogram was developed, and the model was deployed as an interactive web-based tool. The GBM model maintained robust performance across all subgroups.

Conclusions: The GBM model, developed using 6 clinically relevant variables, enables accurate prediction of infrapopliteal artery disease severity and demonstrates its significant potential to support clinical decision-making and improve risk stratification for patients with PAD.Clinical ImpactThis study introduces a Gradient Boosting Machine model to predict the severity of infrapopliteal arterial disease using six readily available variables. For clinicians, this offers a non-invasive, rapid decision-support tool. By accurately predicting lesion severity, the model enables surgeons to better stratify patients, optimize treatment planning, and potentially improve the suboptimal outcomes currently associated with infrapopliteal interventions. This innovation shifts practice towards a more personalized, data-driven approach in the initial assessment of peripheral artery disease.