CVIR Endovascular最新文献

Background: Endovascular therapy (EVT) is a well-established revascularization strategy for patients with peripheral artery disease. However, achieving optimal wire crossing in complex chronic total occlusion lesions remains technically challenging. Intravascular ultrasound (IVUS)-guided wiring facilitates safer and more effective procedures. However, aligning IVUS findings with fluoroscopic imaging is challenging due to catheter rotation. We report a novel technique-termed the IDEAL technique-that leverages the deep vein as an anatomical landmark to correct IVUS rotational orientation.

Case presentation: A 76-year-old female presented with chronic limb-threatening ischemia in the right toe. Contrast-enhanced computed tomography revealed a chronic total occlusion in the right superficial femoral artery. EVT was performed via the right common femoral artery. IVUS revealed that the first guidewire had entered the subintimal space partway through its course. Using preprocedural computed tomography, the deep vein was identified and its clock-face position relative to the artery was determined. This anatomical landmark enabled correction of IVUS image rotation, allowing accurate re-direction of a second guidewire under fluoroscopic guidance, thereby successfully crossing into the intraplaque lumen.

Conclusions: The IDEAL technique quickly provides anatomical orientation by utilizing the deep vein as a landmark during IVUS-guided wiring-making it, quite literally, ideal.

Background: The aim of this study was to compare the use of combined fenestrated and bifurcated aortic endografts to the standard modular design including a proximal fenestrated and a distal, bifurcated endograft. The combined design allows for a modification of the procedure that may contribute to lowering the risk of damaging the target vessel stents and reducing the perioperative obstruction of the ipsilateral access vessel.

Methods: Consecutive patients treated with fenestrated aortic repair between December 2020 and December 2022 were included in this retrospective, single center study. Technical success was analyzed, including the integrity of the target vessel (TV) stents assessed on perioperative CT. Further, the duration during which the large introducer had to be kept in the access vessel was analyzed. Finally, we report technical data on the endograft design, adverse events and midterm results.

Results: Twelve patients were treated with a modular endograft (group A) and 13 patients with a combined endograft design (group B). Technical success was 100% in both groups, however there were 4 deformed target vessel stents in group A, none in group B. The duration of potential flow reduction due to a large introducer in the access vessel was significantly shorter in group B than group A (median 54 min vs. 109.5 min, p < 0.05). No adverse events were reported in any of the groups. The observation period was shorter in group B (median 18 months vs. 33 months, p < 0.05). Except for one case of aneurysm growth in group A, all other patients in both groups showed stable or decreased aneurysm size without TV occlusions.

Conclusions: The integration of the bifurcation on the fenestrated endograft may contribute to the prevention of damage of the TV stents and has potential to reduce the duration of perioperative limb obstruction.

Background: Endovascular stenting is widely accepted as the standard treatment for central venous obstruction syndromes such as superior vena cava (SVC) syndrome due to its demonstrated clinical efficacy and improved patient outcomes. However, its application in axillosubclavian vein thrombosis (ASVT) has been limited due to concerns about stent compression within the thoracic outlet. This report aims to evaluate the feasibility and safety of the off-label use of dedicated venous stents-engineered with enhanced mechanical features-as an alternative endovascular approach for the treatment of ASVT.

Methods: Thirty-eight patients (43 affected limbs) with symptomatic ASVT and no prior treatment or surgical decompression underwent endovascular placement of dedicated venous stents across the thoracic outlet with Abre Venous Stents (Medtronic, Dublin, Ireland), Venovo Venous Stents (BD, Franklin Lakes, NJ, USA), or Vici Venous Stents (Boston Scientific, Marlborough, MA, USA). Stents were extended peripherally to the subclavian or axillary veins and centrally to the brachiocephalic vein or SVC. Technical success was defined as successful stent deployment across the costoclavicular space, and clinical success as symptomatic improvement.

Results: Stent placement was technically successful in all 43 limbs (100%), with clinical improvement observed in 97.4% of patients. The one patient without clinical improvement experienced early thrombosis of the stent, requiring mechanical thrombectomy and additional stenting. Follow-up CT venography at a mean of 301.3 days demonstrated high primary stent patency rates (81.4%), with stent crushing observed in only 7.0% of limbs and no instances of stent fracture. Adverse events were limited, including two access site hematomas and one hypotensive episode, all of which resolved without evidence of long-term complications.

Conclusions: Our findings suggest that stenting across the thoracic outlet for the treatment of ASVT may be a viable option with the use of novel dedicated venous stents, potentially expanding treatment strategies for TCVO.

Background: Uterine artery embolization (UAE) has been a valid tool in the treatment of symptomatic uterine fibroids for a quarter of a century by now. This study aims to examine the impact of this treatment and its development since its introduction in Germany.

Materials and methods: All patients that received inpatient treatment for uterine fibroids (ICD-10 code D25) as primary diagnosis or the primary symptoms of hypermenorrhea/menorrhagia (N92) or dysmenorrhea (N94) with a secondary diagnosis of uterine fibroids from 2005 until 2023 were included. The data was obtained from the research data center of the German Federal Statistical Office. Basic demographic data and all encoded diagnostic and therapeutic procedures were collected and analyzed. Special focus laid on patients receiving either of the three invasive treatments: hysterectomy (HE), myomectomy (ME), and uterine artery embolization (UAE).

Results: One million one hundred sixty-four thousand five hundred sixty-six women were hospitalized in those 19 years with 91.7% receiving either HE, ME or UAE. There was a continuous decline in annual numbers of hospitalizations (-47.7%) and of HE (-55.5%) between 2005 and 2023. Constantly more than 99% of the treated women underwent surgery-contribution of UAE continuously remained below 1%. The highest number of UAE was conducted in 2012 with 568 treated women, followed by a continuous decline to 313 in 2023. The reference population of all women at the age of 30 to < 55 years in Germany decreased only slightly from 15,230,000 to 13,506,000 (-11.3%).

Conclusion: The numbers of inpatient invasive treatment continuously declined disproportionately to the demographic development. Despite excellent evidence, UAE is not used for treatment of symptomatic uterine fibroids to a relevant extent in Germany.

Proximal Interruption of the Pulmonary Artery (PIPA) is a rare congenital condition with an incidence of 1 in 200,000-300,000 individuals. We report the case of a 67-year-old woman with PIPA who presented with massive haemoptysis. Imaging revealed a small calibre right main pulmonary artery, absence of upper/middle lobe pulmonary arteries, and tortuous right systemic collateral arteries. A multidisciplinary meeting favoured bronchial artery embolisation over right pneumonectomy, due to the bleeding risk associated with extensive transpleural systemic collateral arteries. The patient underwent two staged bronchial artery embolisation and remained free of haemoptysis at the most recent 13-month follow-up. This case highlights the potential for bronchial artery embolisation to serve as a first-line treatment in managing PIPA, as a less invasive alternative to surgery.

Introduction: A varicocele is a venous dilatation due to valvular incompetence within the pampiniform plexus, affecting 10-20% of the population and found in 40% of men with primary infertility (Hum Reprod Update 7(1):59-64, 2001, Cochrane Database System Rev (3), 2004, Curr Urol 6(1):33-6, 2012, World J Men's Health 37(1):4, 2019). Varicocele associated pain occurs in 2-10% of cases (Hum Reprod Update 7(1):59-64, 2001, SpringerPlus 4:1-5, 2015). Treatment options include conservative management, percutaneous embolization, or surgery (Urology 72(1):77-80, 2008). In the literature, percutaneous embolization has a technical failure rate ranging from 0 to 13.9% and recurrence rates of around 13% (Cochrane Database System Rev 4(4):CD000479, 2021). This study evaluates the success and recurrence of percutaneous varicocele embolizations over fifteen years and compares the embolic materials used.

Methods: This was a retrospective study of all adult patients who underwent varicocele embolization performed from April 2008 to February 2023 in two tertiary centres. Data collected included patient age, procedure date, access site, side of occurrence, previous interventions, treatment method, need for re-intervention, and recurrence rates. We defined technical success as successful access to the gonadal vein and embolization of same with coil/sclerosant. We assessed clinical success through follow-up telephone consultations and ultrasound.

Results: The technical and clinical success rate was 96% and 93.75%, respectively. Of 225 patients, 3.12% had prior failed surgeries, all were treated successfully with IR, and only 0.89% required further surgical intervention. Patients reported recurrence rate of 25% of cases during telephone follow-up. However, the confirmed actual recurrence rate based on ultrasound was only 6.25%. The complication rate was low (1.78%), with no major events. Among patients treated for subfertility, 51.35% achieved successful conception following percutaneous embolization. Outcomes did not significantly differ based on the type of embolic material used.

Conclusion: Percutaneous embolization is a safe, effective, and durable treatment for varicocele, demonstrating high technical and clinical success regardless of embolic material used with a low recurrence rate over long-term follow-up. It remains effective even in cases of prior failed surgical repair and is associated with promising fertility outcomes. These findings support embolization as a first-line treatment in varicocele management.

Background: Thoracic endovascular aortic repair (TEVAR) has been a feasible treatment option since the first stent graft was approved by the FDA in 2005, and is now the recommended method for treating most descending aorta pathology in the current clinical practice guidelines. Indications for TEVAR include descending aorta aneurysms, traumatic aortic injury and pathology that presents as acute aortic syndrome. More often than not the lesion that needs to be excluded is quite close or contains the distal aortic arch, thus requiring the coverage of the left subclavian artery (LSA) origin, a practice that has been associated with severe complications. Contraindications to LSA coverage resulted in the development of various surgical and endovascular LSA revascularization techniques.

Materials and methods: Branched stent grafts containing a single branch for the LSA are a rapidly evolving technology regarding LSA reconstruction during TEVAR. The aim of this article is to demonstrate our center's experience using a novel off-the-shelf single-branched stent graft, the GORE® TAG® Thoracic Branch Endoprosthesis (TBE) (W. L. Gore & Associates, Inc, Flagstaff, Ariz, USA). The GORE® TAG® TBE is commercially available in Europe since early 2024. We have so far, since February 2024, treated 12 patients using this endograft, successfully treating all types of aortic lesions.

Conclusions: Branched TEVAR is becoming a feasible option for treating descending aorta pathology, without covering the LSA. Moreover, the development of off-the-shelf branched stent grafts, enables physicians to treat patients in the emergency setting, aside from planned procedures.

Background: Iatrogenic superior gluteal artery injury (SGA) following bone marrow biopsy is rare but potentially life-threatening. Due to the deep intrapelvic location of the vessel, conventional management with manual compression or surgical repair is challenging. Traditional management via endovascular coil embolization requires arterial access and vessel sacrifice. Case presentation We present a case of SGA injury resulting from a bone marrow biopsy in a patient with suspected T-cell lymphoma. The injury was successfully managed using a 6 french Angioseal closure device applied directly through the biopsy puncture site in the gluteal region, with the patient maintained in the lateral decubitus position. The approach achieved immediate hemostasis while preserving arterial patency.

Conclusion: This represents the first reported use of an Angioseal device for direct percutaneous treatment of iatrogenic SGA injury. This technique offers an effective hemostasis and vessel preservation, expanding the interventional radiology's armamentarium.

Background: Obesity is a global health challenge, leading researchers to explore innovative treatments. Bariatric arterial embolization (BAE), which blocks blood flow to parts of the stomach, shows promise for weight management by affecting hunger hormones like ghrelin. This study aimed to compare the efficacy and safety of n-butyl-2-cyanoacrylate (NBCA) and microspheres in suppressing weight gain and ghrelin expression after BAE in a swine model.

Materials and methods: Fifteen healthy juvenile male farm pigs were randomly allocated into three groups: NBCA embolization (n = 5), microsphere embolization (n = 5), and a control group (n = 5). Embolization targeted the right, left, and short gastric arteries. Weight and fasting plasma ghrelin levels were monitored weekly for 16 weeks. Gastric endoscopy was performed 1 and 4 weeks post-BAE, and each animal's ghrelin-expressing cells in the stomach's fundus, body, and antrum were analyzed.

Results: By week 16, the NBCA group showed lower weight gain (58.4 ± 17.8%) compared to that in the microsphere (114.0 ± 0.0%; P < .001) and control groups (123.9 ± 18.1%; P < .001). The NBCA group had lower mean ghrelin-expressing cell densities in the gastric fundus (P < .001), body (P = .002), and antrum (P = 0.003) compared to those in the control group, and lower ghrelin-expressing cell densities in the fundus compared to those in the microsphere group (P < .001). Endoscopy at 1-week post-BAE revealed gastric ulcers in 2 pigs in the NBCA group (40%) and all pigs (100%) in the microsphere group, which healed by week 4; no ulcers were found in the control group.

Conclusions: In a swine model of bariatric arterial embolization, NBCA was more effective than microspheres in reducing weight gain and ghrelin expression in the stomach fundus, indicating its potential for managing obesity through BAE.

Background: Prostate artery embolization (PAE) requires a careful understanding of pelvic arterial anatomy and identifying prostatic artery variants. Pre-procedure CTA and intra-procedural cone beam CT are traditional means of planning and performing PAE, with the latter providing guidance for embolization. Photon counting detector (PCD) CT enables ultra-high spatial resolution (UHR) whole-body imaging. For PAE, we obtain a single UHR PCD CT arterial phase acquisition, which provides both detailed pre-procedure pelvic arterial anatomic information and a dataset for 2D (angiographic) to 3D (CTA) fusion for intra-procedural guidance during PAE using embolization guidance software in the angiography suite.

Case presentations: In six patients who underwent technically successful PAE via a left transradial approach, the pre-procedure diagnostic UHR pelvic PCD prostate CTA delineated bilateral prostatic artery origins and course in all cases, as confirmed with conventional angiograms. Further, registration of the UHR PCD CTA for embolization guidance was successful in all cases, augmenting vessel selection. No complication occurred.

Conclusion: UHR PCD CTA is a novel imaging technology that can provide detailed prostate arterial anatomic information for pre-procedure PAE planning. Further, this same UHR PCD CTA dataset can be used for intra-procedural embolization guidance using commercially available embolization guidance software.