CVIR Endovascular最新文献

Background: This is a single-centre prospective observational study examining radial access in 62 Prostatic Artery Embolisation (PAE) procedures. Evaluation of left radial artery diameter using high frequency ultrasound before and after administration of sublingual glycerl trinitrate (GTN). Pre-procedure questionnaires calculating symptom severity score compared with post-procedure.

Results: Sublingual GTN resulted in a statistically significant increase in radial artery diameter (p < .00001). There was a statistically significant reduction in both average International Prostate Symptom Score (IPSS) and Quality of Life (QoL) from pre-procedure to post-PAE. The radial sheath was successfully inserted in 100% of cases. Crossover rate to femoral access was low (4%). Radial artery access had a low complication rate (2%). Radial artery variant anatomy was reasonably common (7%).

Conclusions: Sublingual GTN significantly increase radial artery diameter. PAE from radial access is associated with a symptomatic improvement at 2-month follow-up.

Background: Fractional flow reserve (FFR) can be estimated by analysis of intravascular imaging in a coronary artery; however, there are no data for estimated FFR in an extremity artery. The aim of this concept-generating study was to determine whether it is possible to estimate the value of peripheral FFR (PFFR) by intravascular ultrasound (IVUS) analysis also in femoropopliteal artery lesions.

Methods: Between April 2022 and February 2023, PFFR was measured before endovascular therapy in 31 stenotic femoropopliteal artery lesions. High-definition IVUS measurement was simultaneously performed in automatic pullback mode in 6 of those 31 lesions. IVUS-derived PFFR was calculated by an algorithm based on fluid dynamics as the following equation: ΔP = FV + SV². F is the coefficient of pressure loss because of viscous friction (Poiseuille's equation) and S is the coefficient of local pressure loss because of flow separation (Bernoulli's equation). The values of F and S were calculated by analysis of IVUS. V is velocity and the value of V was obtained from previously reported data in a duplex ultrasound study. The mean pressure was assumed to be 80 mmHg, and IVUS-derived PFFR was calculated by the following equation: IVUS-derived PFFR = (80 - ΔP) / 80.

Results: The values of IVUS-derived PFFR and actual PFFR were similar: 0.73 and 0.72, 0.87 and 0.92, 0.90 and 0.92, 0.66 and 0.73, and 0.79 and 0.72, respectively. In one case in which run-off of the below-the-knee artery was poor, PFFR (0.91) was higher than the IVUS-derived PFFR (0.73).

Conclusion: Virtual PFFR in the superficial femoral artery can be estimated from IVUS analysis.

Background: Three patients with portal hypertension and gastrointestinal bleeding due to non-cirrhotic portal vein thrombosis were treated with portal venous recanalization transjugular intrahepatic portosystemic shunt (PVR-TIPS) via a trans-splenic access.

Main body: A "bottoms-up" retrograde puncture of the right hepatic vein was performed using a re-entry catheter to gain access to the right hepatic vein. In all patients a successful retrograde puncture of the right hepatic vein was achieved, thereby restoring the splenoportal tract.

Conclusion: Our cases present an alternative approach to treat chronic portal vein thrombosis expanding the possibilities of the PVR-TIPS procedure.

Background: The effect of vessel morphology on the technical success and patency of Viabahn stent-grafts in treating postoperative arterial injuries and bleeding (AIB) after hepatopancreatobiliary surgery is not well understood. Difficulties in stent insertion persist despite using stiff guidewires to straighten tortuous vessels. This study aimed to identify vessel morphologies linked to technical success and short-term patency and to explore effective management strategies.

Materials and methods: This retrospective study examined 12 consecutive cases of hepatic artery stenting in 11 patients, using Viabahn grafts for postoperative AIB from 2017 to 2024. Patient data, angiographic outcomes, and stent placement details were reviewed. Different types of guidewires, including stiff and soft guidewires, were utilized to facilitate stent deployment. Vessel tortuosity and vessel narrowing before stent placement were evaluated both qualitatively and quantitatively. Outcomes measured included technical and clinical success rates, stent patency at one month, and the time from surgery to stent placement.

Results: Final technical and clinical success was achieved in all cases (100%). Vessel tortuosity often led to the emergence of accordion-like appearances upon vessel straightening, necessitating additional technical adaptations due to the formation of steps (p = 0.005). One-month stent patency was observed in 10/12 cases (83%). Among cases with severe vessel narrowing distal to the bleeding point, 2/3 (67%) experienced stent occlusion, significantly higher than those with less severe narrowing (p = 0.045). All occluded cases involved the extension of stent length by overlapping stent-grafts.

Conclusions: Steps created by the accordion-like appearance in the hepatic artery resulting from the straightening of tortuous vessels can complicate stent insertion, and severe narrowing distal to the bleeding point increases the risk of short-term occlusion.

Background: Studies on emergency transarterial embolization (TAE) of renal arterial injuries are rare. The aim of this retrospective study was to evaluate clinical outcomes after emergency transarterial renal embolization.

Material and methods: Between January 1st, 2013 and January 1st, 2024, all consecutive patients treated for renal arterial injuries by TAE in emergency settings were retrospectively reviewed. Demographic, biological and angiographic data were recorded. The inclusion criteria were all patients ≥ 18-years-old treated by emergency TAE for renal vascular injury. Clinical success was defined as the resolution of bleeding signs without the need for repeat TAE, surgery, death related to massive blood loss during this period, without functional impairment (> 50% of parenchyma volume or onset of chronic kidney disease) following TAE.

Results: During the inclusion period, 79 procedures were performed. The median age was 60[39-73] years old. On preoperative CT, ≥ 1 pseudoaneurysm was detected in 36(45.6%) patients, and active bleeding in 47(65.8%) patients. The preoperative median haemoglobin rate was 8.9[7.6-11] g/dl, and 37(46.8%) patients required red blood cell transfusions. The main aetiologies of arterial injury were blunt trauma (n = 19) and renal biopsy (n = 17). No severe adverse events were reported. Clinical success was reported in 74(93.7%) of the procedures. Three (3.8%) repeat embolizations were required, and were clinically successful. During the median follow-up of 7[1.5-35.5] months, 9(11.4%) patients died, of which 5(6.3%) occurred within 30 days.

Conclusion: The present study reports high clinical success, low complications and low rebleeding rates of emergency renal TAE.

Purpose: To investigate the incidence, predictors, and outcomes of medical emergencies in patients undergoing IR procedures at a tertiary care center.

Materials and methods: Seven-year retrospective review of all medical emergencies in patients undergoing IR procedures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Medical emergencies included Cardiopulmonary arrest (CPA), or emergencies that required activation of the critical care response team (CCRT). Variables included demographics, procedure details and outcome data including complications and 30-day mortality. Multivariate logistic regression analysis was conducted to identify independent predictors of CPA and 30-day mortality.

Results: Ninety-four patients (50% male) were included with a median age of 60.5 years. Recent or current ICU admission was recorded in 39 patients (43.8%). Comorbidities included diabetes (50%), hypertension (59.6%), coronary artery disease (25.5%), heart failure (21.5%), ESRD (28.7%), active infection 28 (31%), with ASA3 in 64 patients (68%) and ASA4 in 23 (24.5%). The incidence of CPA and CCRT activation was 0.045% and 0.049%, respectively, among 100,000 patients who underwent IR procedures during the study period. Half the events were with venous procedures, followed by non-vascular (33%) and arterial procedures (10.6%). 30-day mortality was 30.5%. Independent predictors of CPA included pulmonary disease (aOR 16.79, 95% CI 2.334-195.3, p = 0.0097), emergency procedures (aOR 11.63, 95% CI 2.517-72.46, p = 0.0035), general anesthesia (aOR 19.41, 95% CI 1.854-491.8, p = 0.0254), and sedation (aOR 13.04, 95% CI 2.081-118.8, p = 0.0108). Predictors of 30-day mortality were CPA (aOR 9.830, 95% CI 2.439-66.66, p = 0.0045) and hypotension as a complication (aOR 16.81, 95% CI 3.766-122.3, p = 0.0009).

Conclusion: Our findings highlight the complexity of patients undergoing IR procedures and the importance of identifying high-risk patients to prevent adverse events in the IR setting.

Background: Lower limb peripheral artery disease classified as Rutherford category IV, is characterized by lower limb ischemic pain both during exertion and at rest. This disease has an unclear course. We aimed to evaluate outcome predictors in this patient group after endovascular therapy. This single-center, retrospective, observational study included 234 consecutive patients (264 limbs), between April 2007 and December 2020. We investigated the disease clinical course after endovascular therapy. The primary endpoint was the wound formation rate 3 years after endovascular therapy.

Results: The mean observation period was 48.2 ± 8.9 months. The patients (61.9% male; mean age, 76 ± 10 years) presented with diabetes (64.1%), and received hemodialysis with chronic kidney disease (35.0%) and ambulatory treatment (85.0%). The average ankle-brachial index before endovascular therapy was 0.69 ± 0.23. Skin perfusion pressure on the dorsal and plantar sides was 38 ± 13 mmHg and 36 ± 12 mmHg, respectively. The wound incidence rates at 1, 2, and 3 years after endovascular therapy were 8.3%, 11.4%, and 14.4%, respectively. Multivariate analysis revealed the following factors associated with wound formation: P2 in inframalleolar/pedal disease category in the Global Limb Anatomical Staging System (hazard ratio: 1.73, 95% confidence interval: 1.22-2.83, P = 0.01), non-ambulatory status (hazard ratio: 1.09, 95% confidence interval: 1.11-1.36, P = 0.02), intervention up to infrapopliteal lesion (hazard ratio: 1.55, 95% confidence interval: 1.17-2.46, P = 0.03), and patient with chronic kidney disease on hemodialysis (hazard ratio: 1.61, 95% confidence interval: 1.32-2.18, P = 0.03).

Conclusions: The 3-year incidence of wound onset in this study was 14.4%. Factors associated with this outcome included P2 in the Global Limb Anatomical Staging System, non-ambulatory status, intervention up to infrapopliteal lesion, and patient with chronic kidney disease on hemodialysis.

Background: Endovascular therapy is an effective method for revascularization in lower extremity artery disease, but treating chronic total occlusion (CTO) remains challenging. This is particularly true for patients with severe calcification, poor run-off in below-the-knee arteries, or limited access sites, where even guidewire (GW) passage can be difficult and bidirectional approaches are often not feasible. The tip-detection (TD) method has been reported as a useful technique in coronary artery CTO interventions, allowing real-time visualization of the GW tip direction. Here, we applied the TD technique for peripheral CTO intervention.

Case presentation: Case 1 involved a 71-year-old man with a right toe ulcer. Angiography revealed total occlusion from the right anterior tibial artery (ATA) to the proximal dorsalis pedis artery. While attempting IVUS-guided parallel wiring, the GW could not advance through the intraplaque route because of severe calcification. We intentionally advanced the GW and IVUS into the subintimal space of the ATA to bypass the calcified lesion and performed IVUS-guided reentry using the TD technique in the distal ATA, where calcification was less severe. The second GW successfully passed through the intraplaque of the distal ATA and into the true lumen of the dorsalis pedis artery. Case 2 involved a 60-year-old man with bilateral intermittent claudication. Angiography revealed severe stenosis of the right common iliac artery (CIA) and CTO of the left CIA. Because of anatomical limitations and access site challenges, the antegrade approach for the left CIA was unsuccessful, and retrograde intraluminal wiring was difficult because of flexion and calcification. We advanced the GW and IVUS into the subintimal space and performed IVUS-guided reentry using the TD technique to access the true lumen of the proximal CIA. Finally, bilateral VBX stent grafts were implanted using the kissing stent technique.

Conclusions: IVUS-guided reentry wiring with the TD technique may offer a useful solution for passing complex peripheral CTO lesions in cases where only a uni-directional approach is feasible.