CVIR Endovascular最新文献

Introduction: Ongoing developments in interventional radiology have enabled the treatment of various musculoskeletal inflammatory disorders via super-selective embolization of abnormal areas of neovascularization. The current convention is to utilize vascular sheaths in these procedures. This study explored a single-center experience with a novel approach utilizing a sheathless microcatheter cannulation technique without the conventional vascular sheath.

Material and methods: A single-center retrospective chart review was conducted, including all eligible adult patients for whom a super-selective embolization was performed to treat an MSK inflammatory disorder between August 2024 and March 2025. The pre-procedural medical records and imaging were reviewed to determine satisfaction of inclusion criteria. The fluoroscopic images from the angiography suite and procedure notes were reviewed to determine technical success and immediate complications.

Results: Twenty-seven procedures were performed for 19 patients. The average age was 47.5 ± 10 years old. The majority of patients were female (13; 68.5%). The most common procedure indication was for treatment of plantar fasciitis with 14 procedures (51.9%). The embolic material of choice was imipenem-cilastatin in all but one procedure (26; 96.3%). The commonest microcatheter size was 1.7 French (21; 77.8%), and the preferred access vessel was the common femoral artery (17; 63%). The technical success rate was 100% without immediate complications. No major post-procedural complications were encountered. Only one minor access site hematoma complication was reported.

Conclusion: This novel sheathless microcatheter approach was found to be feasible, safe, and effective without major complications within our limited sample size.

Rationale and objectives: Emergency embolization is a cornerstone in the management of active bleeding and vascular lesions at risk of bleeding. This study aims to provide a comprehensive overview of emergency embolization technical modalities in a large cohort of patients, with a focus on embolic agent selection depending on vessel and lesion characteristics.

Materials and methods: This retrospective study included consecutive patients who underwent emergency embolization procedures in an interventional radiology department between 2022 and 2024. Data collection included precise type specifications and quantity of embolic agents, diameter and location of targeted vessel, vascular-type lesions, etiology, and technical success rate.

Results: A total of 304 patients (320 procedures, 465 artery embolizations) were analyzed. Most target arteries measured 1.0-1.9 mm in diameter (42.6%). For arteries < 1 mm (13.8%), liquid agents were preferred (46.7%), whereas coils were the most widely used in larger vessels. In active bleeding (32.7%), liquid agents (38.6%) and coils (37.3%) were the most commonly used. For spontaneously resolved bleeding lesions and pseudoaneurysms (33.1% and 14.2% of lesions, respectively), coils were widely used (34.9% and 50.8%, respectively). Coil use was associated with the highest procedural cost. Technical success was achieved in 99.1% of procedures.

Conclusion: In emergency embolization, small-caliber vessels (1.0-1.9 mm) were the most frequently targeted. In cases of active bleeding, liquid embolic agents were favored, with high technical success. Notably, a substantial proportion of lesions were identified on CT without ongoing bleeding at the time of embolization.

Level of evidence: Level 4, Case Series.

The use of paclitaxel-coated devices (PCDs) in peripheral arterial disease continues to generate interest and controversy. The PCD journey to date has been a story of highs and lows. The recently published SWEDEPAD 1 and 2 trials have rekindled discussion regarding efficacy and a potential link to mortality.

Introduction: Due to several issues with endovascular treatment of intracranial symptomatic atherosclerotic disease (ICAD), international guidelines recommend drug therapy as first-line treatment since almost 10 years. Regardless of this, endovascular ICAD treatment has meanwhile progressed, significantly reducing periprocedural complication rates. However, early in-stent restenosis (ISRS) remains, so far, unchallenged. Cardiologists had been at a similar point in the evolution of cardiac artery stenting and challenged ISRS through drug-eluting stents (DES). Therefore, 90d results and restenosis rates of patients treated with DES versus bare-metal stents (BMS) were compared to determine whether DES could also solve the neurovascular problem.

Methods: All endovascular ICAD treatments in 2014-2022 at a single institution through DES were retrospectively compared to all BMS-treatments in regards to periprocedural complications and ISR rates. Perioperative procedures and drug regimen were comparable for all patients, follow-up was carried out 90 days after treatment through digital subtraction angiography, clinical status was recorded by a board certified neurologist.

Results: Fifty-two patients were treated for ICAD with DES, 26 patients received ICAD-treatment with BMS. Patients' demographics and comorbidities were comparable. The periprocedural and ISR-rates were significantly lower in DES compared to BMS.

Discussion: The lower periprocedural complication rate may be due to less complexity of the DES system, while lower ISR in the DES group may be connected to reduced endothelium irritation and proliferation through the eluted sirolimus.

Conclusion: In the population studied, DES achieved equal to better results in comparison to BMS. This study supports a re-evaluation of the role of endovascular ICAD-treatment as first line therapy in the light of the most recent developments on knowledge and techniques.

Background: Endovascular therapy (EVT) for aortoiliac (AI) disease has shown favorable outcomes with recent advances in technology. Furthermore, the transradial approach (TRA) has emerged as a less invasive alternative to transfemoral access, improving patient comfort. However, data on CS implantation using the TRA remain limited.

Case presentation: We report two cases in which a VIABAHN® VBX-CS (W.L. Gore & Associates, Flagstaff, AZ, USA) were successfully deployed for AI disease using the TRA. In both cases, a 6-Fr transradial guiding sheath was used. The CSs were advanced and accurately deployed using a TRA without complications. The completion of the angiography confirmed the proper expansion and positioning of the CS. Both patients were discharged uneventfully without access-site complications.

Discussion: These cases demonstrate the feasibility and safety of AI balloon-expandable CS implantation using the TRA. The evolution of the device has enabled the delivery of relatively large CS using the TRA, expanding the applicability of this less invasive technique.

Conclusion: Transradial CS treatment may be a promising procedure for AI lesions, offering both procedural safety and patient comfort.

Pulmonary sequestration (PS) is the second most common pulmonary congenital malformation, which involves non-functional lung tissue that lacks communication with the tracheobronchial tree and is supplied by aberrant systemic arteries, with venous drainage to either the pulmonary or systemic venous system. This anatomic malformation increases patients' risk of recurrent infection due to the lack of robust gas exchange. Hence, prompt intervention is warranted for favourable outcomes. Surgical resection is the gold standard treatment for PS. However, embolization of aberrant arteries prior to surgery is a promising adjunct to reduce the risk of intraoperative hemorrhage associated with the aberrant arterial supply. Here we report a case of a 47-year-old man with suspected symptomatic extralobar sequestration dual feeders from a subclavian common trunk with an anomalous pulmonary arterial connection. The patient underwent preoperative embolization of feeding and draining vessels using low-profile plug occluders. The patient tolerated embolization and surgical resection with < 50 ml blood loss. Two-month post-operative imaging demonstrated the stable position of plug occluders. This case highlights the role of preoperative embolization with low-profile plug occluders as a safe and effective strategy for achieving hemodynamic control and minimizing intraoperative bleeding risk in anatomically complex pulmonary sequestrations.

Background: To evaluate outcomes of Castor single-branched stent graft combined with in situ fenestration of the left subclavian artery for aortic arch disease.

Methods: A retrospective analysis of 30 patients undergoing TEVAR with Castor stent that was first implanted with the branch in the left common carotid artery (LCCA) followed by in situ fenestration of the left subclavian (LSA) between March 2022 and March 2024 was conducted. Perioperative and follow-up data were collected and analyzed.

Results: The study retrospective analysis of 30 patients comprised 16 (53.3%) with acute type B aortic dissections, 6 (20%) with thoracic aortic aneurysms, 2 (6.7%) with intramural hematoma, and 6 (20%) with penetrating aortic ulceration. The technical success rate was 96.7% (29/30). One patient required carotid-axillary bypass due to subclavian artery lateral wall opening. There were no cases of mortality, stroke, upper limb ischemia, paraplegia, or stent graft-induced new entry within the 30-day follow-up period. Median hospitalization was 11 (IQR, 9-14) days, with a median follow-up of 12 (IQR, 8-19) months. One patient (3.3%) suffered a fall-related cerebral hemorrhage unrelated to the procedure. Another (3.3%) developed left upper limb ischemia due to stent angulation, corrected with a cover stent. Subclavian artery patency was 96.6% (28/29), and carotid artery patency was 100%. No deaths, endoleaks, or stent migrations occurred.

Conclusion: The Castor stent combined with in situ fenestration is a feasible, effective, and safe strategy for aortic arch disease repair, especially in providing alternative approaches for aortic diseases that require reconstruction in both branches.

Background: Consistent with global trends, the incidence of placenta accreta spectrum (PAS) is increasing in Australia. Prophylactic internal iliac arterial balloon occlusion (PIIABO) is an endovascular intervention utilised to assist haemorrhage control during caesarean delivery in women with PAS, offering a potentially uterus-preserving alternative to hysterectomy. However, existing outcomes remain heterogeneous. This study aimed to evaluate the endovascular safety of PIIABO with immediate sheath removal in the management of PAS, with a secondary assessment of haemostatic and procedural outcomes.

Materials and methods: A 10-year retrospective, single-centre cohort study of all patients with suspected PAS who underwent PIIABO was conducted with data obtained from electronic medical records and Radiology Information System (RIS)/Picture Archiving and Communication System (PACS).

Results: Fifteen patients underwent PIIABO. The mean maternal age was 34.1 years, with a mean gravidity of 4.2 and a parity of 2.3; all had prior caesarean delivery and 93% had concurrent major placenta praevia (n = 14). Mean gestational age at delivery was 34.9 weeks. Diagnosis was established by MRI (n = 11, 87.5% concordance) and ultrasound (n = 4, 50% concordance). Twelve patients underwent hysterectomy, confirming 1 accreta, 3 increta, and 8 percreta; 3 patients preserved uterus, with intraoperative evidence of percreta (n = 2) or normal placentation (n = 1). Mean estimated blood loss was 2273 mL, and 11 patients received blood transfusions, including four who required ≥ 4 units of packed red blood cells. Mean balloon inflation time was 129.9 min, sheath dwell time 265.5 min, and operating theatre time 265.7 min. Mean dose-area product was 55.03 Gy.cm² with a mean fluoroscopy time of 10.7 min. Radiation exposure decreased by approximately 90% over the study period with increasing institutional experience. No endovascular complications or reinterventions occurred, and all mothers and neonates were discharged without long-term morbidity.

Conclusion: PIIABO with immediate sheath removal demonstrated favourable procedural outcomes and a low complication rate in patients with PAS, supporting its safe implementation within a multidisciplinary care pathway.